Hip fracture represents a significant challenge, placing increasing pressure on health and social care services in Scotland. This study establishes the ‘historic’ hip fracture burden, namely, the annual number of hip fractures in Scotland, and respective incidence, between 2017 – 2021. Furthermore, the ‘projected’ hip fracture burden and incidence from 2022 – 2029 was estimated, to inform future capacity and funding of health and social care services.

The number of individuals with a hip fracture in Scotland between 2017 and 2021 was identified through the Scottish Hip Fracture Audit, enabling the annual number of hip fractures and respective incidence between 2017 – 2021 to be calculated. Projection modelling was performed using Exponential Smoothing and Auto Regressive Integrated Moving Average to estimate the number of hip fractures occurring annually from 2022 – 2029. A combined average projection was employed to provide a more accurate forecast. Accounting for predicted changes within the population demographics of Scotland, the projected hip fracture incidence up to 2029 was calculated.

Between 2017 and 2021 the annual number of hip fractures in Scotland increased from 6675 to 7797 (15%), with an increase in incidence from 313 to 350 per 100,000 (11%) of the at-risk population. Hip fracture was observed to increase across all groups, notably males, and the 70–79 and 80–89 age cohorts. By 2029, the combined average projection estimated the annual number of hip fractures at 10311, with an incidence rate of 463 per 100,000, representing a 32% increase from 2021. The largest percentage increase in hip fracture by 2029 occurs in the 70–79 and 80–89 age cohorts (57% and 53% respectively). Based upon these projections, overall length of hospital stay following hip fracture will increase by 60699 days per annum by 2029, incurring an additional cost of at least £25 million.

Projection modelling demonstrates the annual number of hip fractures in Scotland will increase substantially by 2029, with significant implications for health and social care services. This increase in hip fracture burden and incidence is influenced strongly by changing population demographics, primarily an ageing population.

The hip fracture burden on health and social care services in Scotland is anticipated to increase significantly, primarily driven by an ageing population. This study forecasts future hip fracture incidence and the annual number of hip fractures in Scotland until 2029.

The monthly number of patients with hip fracture aged ≥ 50 admitted to a Scottish hospital between 01/01/2017 and 31/12/2021 was identified through data collected by the Scottish Hip Fracture Audit. This data was analysed using Exponential Smoothing and Auto Regressive Integrated Moving Average forecast modelling to project future hip fracture incidence and the annual number of hip fractures until 2029. Adjustments for population change were accounted for by integrating population projections published by National Records of Scotland.

Between 2017 and 2021 the annual number of hip fractures in Scotland increased from 6675 to 7797, with a respective increase in hip fracture incidence from 313 to 350 per 100,000. By 2029, the averaged projected annual number of hip fractures is 10311, with an incidence rate of 463 per 100,000. The largest percentage increase in hip fracture occurs in the 70-79 age group (57%), with comparable increases in both sexes (30%). Based upon these projections, overall length of stay following hip fracture will increase from 142713 bed days per annum in 2021, to 203412 by 2029, incurring an additional cost of over £25 million.

Forecast modelling demonstrates that the annual number of hip fractures in Scotland will rise substantially by 2029, with considerable implications for health and social care services.

Aims

The aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients.

Background:

Injuries inflicted by gunshot wounds (GSW) are an immense financial burden on the South African healthcare system. The cost of treating an abdominal GSW has previously been estimated at R30 000 per patient. No study has been conducted to estimate the financial burden from an orthopaedic perspective.

Purpose: Litigation continues to be a concern in orthopaedic surgery despite suggestions on how to contain liability. The purpose of this study was to characterize orthopaedic litigation in Canada from 1997–2006.

Method: This study reviewed all closed claims reported to the Canadian Medical Protective Association (CMPA) for 1997–2006 in which orthopaedic surgeons were named. There were 11,983 closed legal actions involving CMPA members (> 73,000 physicians), and 1,353 involved orthopaedic surgeons. A careful review of closed legal actions is a recognized tool for risk identification, assessment and management. The CMPA identifies any critical incidents within the closed legal files. A critical incident is defined as any omission or commission in the evaluation or management which led to the problem(s) that triggered the legal action. Each closed legal action can have more than one critical incident.

Results: Performance, diagnostic and communication issues were the most frequently identified problems. These three areas account for 55% of the critical incidents identified. Performance related issues accounted for 395 critical incidents (29%). Diagnostic issues, including deficient histories and general evaluations, were identified in 281 cases (21%). Communication-related critical incidents included those concerning informed consent. The lack of informed consent was a common allegation, proven in 71 cases. In 439 cases (32%) there was no identifiable critical incident for the orthopaedic surgeon involved. Seventy-eight per cent of patients experienced minor or no disability and 22% experienced major disability or death. Events related to tibia trauma and knee arthroscopy formed the two major categories of claims. Patient care areas of high risk include the operating room and outpatient clinic. Overall, 31% of legal actions against orthopaedic surgeons had outcomes in favour of the plaintiffs, compared with 33% of all CMPA members’ claims.

Conclusion: Although the likelihood for an orthopaedic surgeon to be sued in Canada has decreased over the last 10 years, the percentage of legal cases resolved in favour of plaintiffs has remained stable. Performance-related deficiencies, delays in diagnosis, and failures in communication represent areas of high medico-legal risk. Suggestions for risk management are provided to further decrease adverse events and the medico-legal risks for Canadian orthopaedic surgeons.

Purpose: Wrong sided surgery is a devastating, yet avoidable adverse event. The Committee on Orthopaedic Practice & Economics (COPE) position paper on wrong sided surgery in Orthopaedics in 1994 had proposed to develop a reproducible method of operating on the correct side and to educate the orthopaedic community about the standardized procedure and accept this as the standard of care. An update to the COA Membership on success of the position paper was published in the COA Bulletin in 2002. Correspondence from the Canadian Medical Protective Association (CMPA) had demonstrated that there were some encouraging results. There had been a reduction from approximately 13 cases per year in 1987 to five cases per year in 2000. The most common anatomical site involved the incorrect knee. Now 10 years after its acceptance as the standard of care in Canada for orthopaedic surgeons at the COA Meeting in 1995, have all cases of wrong sided surgery been eliminated?

Methods: A search of the CMPA files of malpractice claims as well as cases that were labeled as threats occurring between January 2001 and September 2005 naming a physician and involving the issue of wrong sided surgery were performed.

Results: A review of the synopses found 26 cases where wrong site surgery was the central issue. There were 9 cases in 2001, 10 in 2002, 3 in 2003, 3 in 2004 and 1 in 2005. The 26 cases were reviewed in detail and some of the general characteristics were identified. Of those 26 cases, 10 involved the incorrect knee; in 9 cases, an arthroscopy was performed on the wrong knee; in one case, a total knee replacement was performed on the wrong knee. Hand and foot cases usually involved the wrong finger or toe.

Conclusions: Despite the position paper from the COA (OPERATE THROUGH YOUR INITIALS), operating room policies, heightened awareness, information and educational sessions at all levels of training, wrong site surgery continues to recur. Review of the files for risks have identified the following trends: patients had been anesthetized, the extremity prepared and draped without the surgeon seeing the patient first, the surgical area had been marked by a person other than the surgeon, the medical record and/or radiographs were not available in the operating room, and the hospital policy was not followed. Surgeons need to be mindful that wrong sided surgery has not been eliminated, and educate their surgical team in its prevention.

Introduction. Plain radiograph underestimates the lysis extent while bone defect determines acetabular revision. We determine the multislice computed tomography (CT) efficacy with metal-artifact minimization to calculate the volume, extent and location of lytic lesions around a loose acetabular cup.

Patients and Methods. 48 hips with a loose acetabular cup were evaluated before cup revision. Multislice CT scans with metal-artifact minimization (Toshiba-MEC CT) were done. Scans were taken at 135 kV and 250 mA to maximize the resolution and bone contrast. CT slice thickness was 3 mm and reconstruction index 1.5 mm. Evidence of osteolytic lesion on these scans was compared with plain radiographs and with intraoperative findings. Bone defects were classified according to Paprosky.

Results. Acetabular lysis were found in the radiographs of 18 hips and in the CT scans of 36 hips. The most frequent locations of osteolysis were medial (32 hips) and posterior walls (23 hips). Radiographs underestimated the extent of the lysis: there were 28 hips with radiographic type 1 defects and 16 hips with CT defects; 6 and 11 with type 2; 8 and 10 with type 3A; and 6 and 11 with type 3B respectively (Wilcoxon test, p< 0.001). The mean volumetric bone loss was 35.4 cm3 . Intraoperative findings confirmed CT findings.

Conclusions. Multislice CT scans with metal-artifact minimization is more sensitive for identifying and quantifying osteolysis around the cup than are plain radiographs. Since CT scans allow us to show the extent and location of the osteolysis, they are useful to plan cup revision.

Aim: The aim of this study was to determine the signiþcance of radiolucent lines observed around the MG unicompartmental knee replacement. Method: Weight bearing AP and lateral þlms of 75 knees were reviewed in 56 patients. Each patient had pre-op, post-op and up to date þlms reviewed. On each postoperative þlm the prosthesis was divided into zones. Each zone was observed for evidence of a radiolucent line suggestive of loosening. Results: 75 unicompartmental replacements were performed in 56 patients. The mean follow up was 67.2 months (24–112 months). The femoral component showed no radiolucent lines in any zone in 97% of the knees. 79% of the knees showed no radiolucent lines on the AP view of the tibial component and 71% showed no evidence of radiolucent lines on the lateral view of the tibial component. The most frequent observation was the presence of a radiolucency in zone 1 on both the AP and lateral view of the tibial component. The early appearance of a radiolucency in zone 1 did not progress to aseptic loosening of the implants. Conclusion: The femoral component of the MG implant very rarely shows evidence of radiolucent lines suggestive of loosening. The presence of a radiolucent line in zone 1 of the tibia on the AP or lateral þlm does not lead to early failure of the implant.