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Introduction: The estimated incidence of hip fractures worldwide was 1.26 million in 1990 and is expected to double to 2.6 million by 2025. The cost of care for hip fracture patients is a significant economic burden. This study aimed to look at the inpatient cost of hip fractures among elderly patients placed under a mature orthogeriatric co-managed system.Methods: This study was a retrospective analysis of 244 patients who were admitted to the Department of Orthopaedics of Tan Tock Seng Hospital, Singapore, in 2011 for hip fractures under a mature orthogeriatric hip fracture care path. Information regarding costs, surgical procedures performed and patient demographics was collected.Results: The mean cost of hospitalisation was SGD 13,313.81. The mean cost was significantly higher for the patients who were managed surgically than for the patients who were managed non-surgically (SGD 14,815.70 vs. SGD 9,011.38; p < 0.01). Regardless of whether surgery was performed, the presence of complications resulted in a higher average cost (SGD 2,689.99 more than if there were no complications; p = 0.011). Every additional day from admission to time of surgery resulted in an increased cost of SGD 575.89, and the difference between the average cost of surgery within 48 hours and that of surgery > 48 hours was SGD 2,716.63.Conclusion: Reducing the time to surgery and preventing pre- and postoperative complications can help reduce overall costs. A standardised care path that empowers allied health professionals can help to reduce perioperative complications, and a combined orthogeriatric care service can facilitate prompt surgical treatment. [ABSTRACT FROM AUTHOR]

There is a paucity of available research on knowledge of orthopaedic implant costs and healthcare schemes among orthopaedic residents. With the rising healthcare costs in Singapore, it is imperative for residents, who are the future surgeons, to understand these issues in order to provide proper counselling and cost-effective management. This study aimed to quantify how accurately they understood these issues and determine if senior residents had better knowledge given their increased experience. An online survey was administered to all orthopaedic residents within a residency programme. There was poor knowledge of implant costs and healthcare schemes among residents. Junior residents fared better at healthcare schemes, while senior residents fared better at estimation of implant costs. Education on these issues should be incorporated into the residency programme to bring about more holistic and cost-conscious clinicians. [ABSTRACT FROM AUTHOR]

Injury to the distal tibiofibular syndesmosis can be a diagnostic challenge in the absence of advanced imaging. We report a case of a 21-year-old male patient who sustained an ankle injury and demonstrated radiological evidence of syndesmosis widening on plain radiographs. He underwent endobutton fixation which resulted in anterior subluxation of the talus and difficulty in ankle dorsiflexion. This is the first case report in the literature of a functional syndesmotic widening and the subsequent sequelae when subjected to a stabilisation procedure. The previously reported risk factors were inconsistent with our patient's demographics of a young, previously obese adult. We postulate that his childhood morbid obesity likely contributed to the functional widening of his ankle syndesmosis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ong et al.)

There is a paucity of available research on knowledge of orthopaedic implant costs and healthcare schemes among orthopaedic residents. With the rising healthcare costs in Singapore, it is imperative for residents, who are the future surgeons, to understand these issues in order to provide proper counselling and cost-effective management. This study aimed to quantify how accurately they understood these issues and determine if senior residents had better knowledge given their increased experience. An online survey was administered to all orthopaedic residents within a residency programme. There was poor knowledge of implant costs and healthcare schemes among residents. Junior residents fared better at healthcare schemes, while senior residents fared better at estimation of implant costs. Education on these issues should be incorporated into the residency programme to bring about more holistic and cost-conscious clinicians., (Copyright: © Singapore Medical Association.)

Introduction: The estimated incidence of hip fractures worldwide was 1.26 million in 1990 and is expected to double to 2.6 million by 2025. The cost of care for hip fracture patients is a significant economic burden. This study aimed to look at the inpatient cost of hip fractures among elderly patients placed under a mature orthogeriatric co-managed system., Methods: This study was a retrospective analysis of 244 patients who were admitted to the Department of Orthopaedics of Tan Tock Seng Hospital, Singapore, in 2011 for hip fractures under a mature orthogeriatric hip fracture care path. Information regarding costs, surgical procedures performed and patient demographics was collected., Results: The mean cost of hospitalisation was SGD 13,313.81. The mean cost was significantly higher for the patients who were managed surgically than for the patients who were managed non-surgically (SGD 14,815.70 vs. SGD 9,011.38; p < 0.01). Regardless of whether surgery was performed, the presence of complications resulted in a higher average cost (SGD 2,689.99 more than if there were no complications; p = 0.011). Every additional day from admission to time of surgery resulted in an increased cost of SGD 575.89, and the difference between the average cost of surgery within 48 hours and that of surgery > 48 hours was SGD 2,716.63., Conclusion: Reducing the time to surgery and preventing pre- and postoperative complications can help reduce overall costs. A standardised care path that empowers allied health professionals can help to reduce perioperative complications, and a combined orthogeriatric care service can facilitate prompt surgical treatment., (Copyright: © Singapore Medical Association)

Retrograde cement extrusion into the nutrient vessels of the femur is a rare phenomenon in uncomplicated cemented hemiarthroplasty of the hip; this is a report on three cases. Routine postoperative radiographs showed a continuous dense linear opacity arising from the posterior medial region of the femur. Computed tomography (CT) scans revealed no evidence of a cortical break in the femur and confirmed our suspicion of retrograde cement extrusion into the nutrient vessels of the femur. Post-operative recovery was uneventful with no complications of cement thromboembolism. Our findings in three cases suggest that cement retrograde extrusion into nutrient vessels following hemiarthroplasty is a benign complication of modern cementing techniques involving pressurisation. The site of cement extrusion into the nutrient foramina displays a constant topography. We recommend that a CT scan of the femur be done on detection of a radio-opaque density on postoperative radiographs to differentiate an extraosseous breach from an intra-vascular extrusion of cement. The theoretical complications of cement embolism and thrombosis should be kept in mind and looked for clinically.