ANZ Journal of Surgery最新文献

Objective: Explore the differences in ultrasound reporting between community ultrasound centres and a high-volume paediatric tertiary centre in diagnosing developmental dysplasia of the hip (DDH).

Participants: One hundred infants less than 6 months of age from a paediatric hip registry, who underwent ultrasounds in both community and tertiary centres within a 2-week interval.

Results: One percent of a 200-hip sample reported scan quality. Alpha angles were reported in 84.5% (n = 169) of community reports and 78.5% (n = 157) of tertiary centre reports. Femoral head coverage was reported similarly in both environments at 94.5% in community and 93.5% in tertiary. Beta angle appeared in 45% (n = 90) and 2% (n = 4), respectively. Bland Altman plots revealed that there existed variation in ultrasound interpretation especially in more dysplastic hips. The concordance correlation coefficient showed only moderate agreement (Rho = 0.60 for alpha angles, Rho = 0.61 for femoral head coverage), and interrater reliability on hip classification reached moderate agreement (Cohen's Kappa = 0.57 for alpha angle, and 0.45 for femoral coverage) between community and tertiary hospital reports.

Conclusions: Reliance on the community-acquired ultrasound report as a true reflection of the state of a hip is not completely justified. The lack of standardized reporting poses challenges for community clinicians in starting treatment or making appropriate referrals. Only a moderate agreement has been observed between the community and tertiary scans. Consequently, over 25% of hips classified as abnormal are potentially normal, and more than 15% dysplastic hips could be undetected.

Background: E-scooter associated injury patterns are well described, but less is known about the riders. This study describes the epidemiological characteristics of injured riders with the aim of providing information for preventative strategies.

Methods: A retrospective review of prospectively collected data on admissions (2021) and all hospital presentations (2022-2023) to the Royal Melbourne Hospital, due to injury in a rider of an e-scooter. Data collected were demographics (age, gender, postcode), drug and alcohol usage, helmet usage, circumstances of injury (how, where and when), reported speed, and insurance status. Data was analysed with multiple cross tabulations using two-sided Fischer's exact test.

Results: Over the 3 years 562 cases were identified, with a median age 29 years (IQR 23-40), 383 (68.5%) were male. Alcohol (29.5%) and drug (10.9%) usage were prevalent. The majority (70.4%) "fell off" without collision, 274 were admitted, and 9.6% were major trauma. Alcohol usage was more likely seen in men (P = 0.006), in major trauma (P = 0.02) but showed no association with age. Speed over 20 km/h was seen in 38.5% when recorded and associated with drug usage and major trauma status but not alcohol. Medicare ineligibility patients (12.1%) were younger, more likely to be female (P = 0.012) and less likely to use drugs (P = 0.001) and alcohol (P < 0.001).

Conclusion: This hospital level data of injured e-scooter riders has shown high prevalence of alcohol and drug usage and speeding, all of which were associated with more severe injury, and are hence prime targets for injury prevention.

Background: Melbourne, Australia was considered the most locked-down city during the COVID19 Pandemic. School was conducted from home and all organized sport ceased. Our institution noted an increased presentation of bone stress injuries (BSI) ranging from periostitis to stress fractures. This study reviews the prevalence of these injuries to gain insights into BSI presentation, diagnosis and best management.

Methods: A retrospective review of lower limb long bone stress injuries between April 1st 2020 and March 31st 2022, and from 2018 to 2020 for comparison, was conducted. A chart review of those meeting inclusion criteria for demographics, fracture characteristics, investigations, and treatment administered was conducted.

Results: Thirteen patients (two female, 11 male) met inclusion criteria. Only four patients were identified in the comparison period. The average age was 11.6 years, and average symptom duration was 7 weeks. Distinct morphologies were noted, specifically three discrete patterns of tibial injury were identified. Patients underwent an average of three imaging studies prior to diagnosis. Nine of 13 patients were prescribed a period of non-weight bearing, averaging 3.5 weeks. Seven of 13 patients were prescribed a formal 'partial weight bearing' (50%) period averaging 6.4 weeks.

Conclusion: There was a significant increase in paediatric BSI presentation over the COVID-19 lockdowns. This may be linked to the effect of reduced physical activity. Knowledge of the three clear tibial morphologies identified in this study will inform future diagnosis and reduce investigation expenditure. These findings may inform public health measures during mandated lockdowns and raise a diagnostic framework for such injuries.

Background: Tracheostomy is frequently performed in an intensive care unit setting to progress the care of intubated patients. A multidisciplinary team follows up tracheostomised patients once transferred to the ward. A virtual tracheostomy multidisciplinary meeting (MDM) was established with the aim to standardize care for these patients.

Methods: A retrospective review of ward-based patients discussed in a Tracheostomy MDM was performed at The Alfred Hospital, a tertiary hospital providing a state-wide trauma service. Two groups were compared; (i) Outreach group comprising patients who were managed prior to the establishment of the Tracheostomy MDM on the 26 July 2021; (ii) Virtual Tracheostomy MDM (V-MDM) group who were managed after the establishment of the Virtual Tracheostomy MDM. Primary outcome was decannulation time from ICU discharge.

Results: There were 65 patients in the Outreach group over 134 weeks. There were 44 patients in the V-MDM group over 94 weeks. There was a significant difference between groups in the median time to decannulation from ICU discharge (P = 0.007) and the overall time to decannulation (P = 0.029) with the V-MDM group requiring a longer period with tracheostomy prior to decannulation. There were no significant differences in the overall hospital length of stay (LOS) or rate of adverse events.

Conclusion: Implementing a supplemental Tracheostomy MDM in a virtual format may not improve time to decannulation and can possibly delay decannulation compared to an established tracheostomy team led by ICU clinicians. Virtual Tracheostomy MDM may have a role in managing patients were a non-virtual ICU-led team is not feasible.

This case involves a patient with an articular base fracture of the distal phalanx, as indicated by the white arrows in the plain radiographs of the left hand: (a) posteroanterior, (b) oblique, and (c) lateral views. The fracture was treated using transosseous indirect reduction, a minimally invasive technique that provides stable fixation, facilitates early post-operative recovery, and reduces surgical complications compared to conventional methods.