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Superficial pin site infection is a common problem associated with external fixation, which has been extensively reported. However, the incidence and risk factors with regard to deep infection are rarely reported in the literature. In this study, we investigate and explore the incidence and risk factors of deep infection following circular frame surgery. For the purpose of this study, deep infection was defined as persistent discharge or collection for which surgical intervention was recommended.This study is retrospective review of all patients who underwent frame surgery between April 1, 2015 and April 1, 2019 in our unit with a minimum of 1 year follow-up following frame removal. We recorded patient demographics, patient risk factors, trauma or elective procedure, number of days the frame wasThree-hundred and four patients were identified. Twenty-seven patients were excluded as they were lost to follow-up or had their primary frame surgery as a treatment for infection. This provided us with 277 patients for analysis. The mean age was 47 years (range: 9-89 years), the male to female ratio was 1.5:1, and 80% were trauma frames. Thirteen patients (4.69%) developed deep infection, and all occurred in trauma patients. Of the 13 patients who developed deep infection, 4 had infection before frame removal, and infection occurred in 9 after frame removal. Deep infections occurred in 8 patients within a year of frame removal and in one patient between 1 and 2 years of frame removal.Within the 13 frame procedures for trauma, 12 were periarticular multi-fragmentary fractures, 3 of which were open, and the remaining were an open diaphyseal fracture. The periarticular fractures were more likely to develop deep infection than diaphyseal fractures (p = 0.033). Twelve patients (out of 13) also had concurrent minimally invasive internal fixation with screws in very close proximity of the wires.The rate of deep infection following circular frame surgery appears to be low. Pooled, multi-centre data would be required to analyse risk factors; however, multi-fragmentary, periarticular fracture and the requirement for additional internal fixation appear to be an associated factor.Ting J, Moulder E, Muir R

Aims A pilon fracture is a severe ankle joint injury caused by high-energy trauma, typically affecting men of working age. Although relatively uncommon (5% to 7% of all tibial fractures), this injury causes among the worst functional and health outcomes of any skeletal injury, with a high risk of serious complications and long-term disability, and with devastating consequences on patients’ quality of life and financial prospects. Robust evidence to guide treatment is currently lacking. This study aims to evaluate the clinical and cost-effectiveness of two surgical interventions that are most commonly used to treat pilon fractures. Methods A randomized controlled trial (RCT) of 334 adult patients diagnosed with a closed type C pilon fracture will be conducted. Internal locking plate fixation will be compared with external frame fixation. The primary outcome and endpoint will be the Disability Rating Index (a patient self-reported assessment of physical disability) at 12 months. This will also be measured at baseline, three, six, and 24 months after randomization. Secondary outcomes include the Olerud and Molander Ankle Score (OMAS), the five-level EuroQol five-dimenison score (EQ-5D-5L), complications (including bone healing), resource use, work impact, and patient treatment preference. The acceptability of the treatments and study design to patients and health care professionals will be explored through qualitative methods. Discussion The two treatments being compared are the most commonly used for this injury, however there is uncertainty over which is most clinically and cost-effective. The Articular Pilon Fracture (ACTIVE) Trial is a sufficiently powered and rigorously designed study to inform clinical decisions for the treatment of adults with this injury. Cite this article: Bone Jt Open 2021;2(3):150–163.

Since Donald Trump’s Electoral College victory in November 2016, the concept of “sanctuary” has garnered renewed national attention. Originally a faith-based concept used to describe the sheltering...

Objectives: To analyze functional and radiologic outcomes of tibial shaft fractures treated with the Taylor spatial frame (TSF). Design: Prospective follow-up study of radiologic and functional outcomes. Setting: University teaching hospital. Patients: From January 2006 to December 2012, prospective data were collected for 56 consecutive patients completing treatment of a tibial shaft fracture with the TSF. Intervention: Treatment of tibial shaft fractures, including those with simple extension into the knee or ankle joints, using the TSF. Main Outcome Measurements: Residual deformity on x-ray and functional outcomes using the EQ-5D health status questionnaire, Iowa Knee and Ankle Evaluation Rating System scores, and Olerud and Molander Ankle score were recorded 1 year after frame removal. Results: Average residual deformity was 1.8 degrees in the coronal and 1.6 degrees in the sagittal planes. EQ-5D outcomes showed patients returning to a health status no different from scores for the UK population as a whole. Iowa Knee scores demonstrated “good” or “excellent” outcomes in 87.3% of our cohort (mean, 90). Ankle Evaluation Rating System scores and Olerud and Molander Ankle scores showed “good” or “excellent” outcomes in 76.8% and 89.3% of our cohort, respectively (mean, 84.1 and 84). Conclusions: Use of the TSF for treatment of tibial fractures, with support from a dedicated limb reconstruction rehabilitation team, has a number of technical advantages while producing good functional and surgical outcomes, with patients recovering to a pre-injury health status. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Introduction. Intramedullary nail is an important component of modern treatment of pertrochanteric femur fractures. Objective. In elderly population, pertrochanteric fractures treated with unreamed intramedullary nails cause less deep infections when compared to reamed intramedullary nails. Patients and Methods. From April, 2010 to May, 2012 at the Department of Orthopedics and Traumatology, Gaetano Rummo Hospital (Benevento, Italy), 156 patients with pertrochanteric fracture, average age 82.7 years (75-102 years), were treated. In the analyzed case, there were 90 females and 66 males with pertrochanteric fractures. The respondents were divided into two groups. The first group consisted of 78 respondents who were treated with reamed intramedullary nails and the second group of 78 respondents treated with unreamed intramedullary nails. Discussion. Infections are not the most common postoperative complications. The risk of infection is increased in patients with comorbidity and in cases when there is an empty space between the intramedullary nail fixation and bone. Proximal femoral fractures carry a high mortality, but its causes are unclear. Conclusion. Our research has shown that the application of unreamed intramedullary nails in the treatment of pertrochanteric femoral fractures reduces a mortality risk and risk of infection.

The idea that user consultation is central to effectiveness, quality and efficiency is still relatively new in many public service organisations, including libraries. This paper reviews the methods available and describes the results of a survey of all UK public library authorities to find out what methods they employ, their effectiveness, and in which context they are used. Recommendations are also made for improving user consultation within libraries.

Recent years have witnessed an increasing interest in the concept of ‘recovery’ in the field of mental health and psychiatry. Anthony (1993) described personal recovery as occurring in the presence of ongoing symptoms but involving ‘a way of living a satisfying, hopeful and contributing life even with limitations caused by illness’ (Anthony, 1993). Recovery from mental illnesses has been conceptualized to involve not only remission of symptoms and achievement of psychosocial milestones but also subjective changes in how persons appraise their lives and the extent to which they experience themselves as meaningful agents in the world (Jacobson & Greenley, 2001). Diverse forms of recovery are possible. In people with optimal outcome, recovery may produce important remission and changes, including the exit from mental health services for a long time period or, sometimes, permanently (Emsley et al, 2011). For other patients, it may mean continuing to receive medical, personal or social support, enabling people to get on with their lives (Emsley et al, 2011). However, in all conditions, the role played by the service in promoting, maintaining and restoring an adequate level of recovery for each patients is pivotal.

Aims: To estimate the prevalence of limited health literacy in patients receiving clozapine for schizophrenia. To develop and produce a pharmacist-designed clozapine patient information leaflet (PIL) which has a higher readability score than the company–produced PIL. Study design: This was a cross sectional prevalence study. Methods: Ethical approval for the study was granted by the local ethics committee. Patients, over 18 years, attending the Clozapine Clinic of a Cork urban teaching hospital, were asked to participate in the study. Demographics such as gender, age, employment and smoking status, were gathered from all participants. The total daily clozapine dose, duration of clozapine treatment, and information regarding the clozapine DVD was also noted. The Rapid Estimate of Adult Literacy in Medicine (REALM) health literacy (HL) screening tool was then administered to each patient. A user-friendly PIL on clozapine was designed by the pharmacist, which was assessed for readability and compared to the company-produced PIL using the FRES and FKGL. Data were analysed using SPSS Version 15. Results: Forty patients (65% male, 95% unemployed and 70% smokers) of average age 38.0 years (±11.2) completed the REALM. The average score was 60.6 (±8.7). Twenty-nine patients (72.5%) were found to have “adequate” health literacy. The remaining eleven patients were found to have either “marginal” or “low” health literacy. The pharmacist-designed PIL would have been readable by 95% of the study population, in contrast to 72.5% with the company-designed PIL. Conclusions: More than a quarter of the population were found to have marginal or low health literacy. Patient information should be matched to the health literacy level of the target population.

Summary for policymakers of the thematic assessment of the sustainable use of wild species of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services