Abstract Background Orthogeriatric services have been shown to improve quality of care for older patients post hip fracture and have an impact on length of stay (LOS), both acutely and in the rehab setting(1) but other key performance indicators (KPIs) have not been examined in detail. Methods Data was prospectively collected on all hip fracture patients seen by the Orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb 2018. We examined KPIs including LOS on the orthopaedic ward, rehab admissions, rehab LOS, new nursing home (NH) admissions. We compared the proportions discharged directly home instead of to convalescence, and conducted a preliminary cost benefit analysis. Results Similar numbers of patients were seen in each time period (n=146 v n=139). Mean reduction in LOS on the orthopedic ward was 3.5 days (15.5 days vs 19 days). The proportion of patients admitted to rehabilitation increased from 8.8% to 17.5% (p = 0.02). Patients got to rehabilitation faster and for those patients who availed of rehabilitation they had significantly shorter total length of stays (51.1 days vs 71.6 days, p=0.029). Fewer patients went to convalescence. Although not statistically significant there was a trend towards an increased proportion of patients discharged directly home (32.7% to 43.6%) and less new nursing home admissions (6.8% vs 8.4%). A cost benefit analysis incorporating shortened acute and rehab LOS and a reduction in spending on convalescence resulted in a projected saving of €480,390 over a six month period. Conclusion Introduction of OrthoGeriatric services has improved care for older people with hip fractures and has resulted in positive improvements to KPIs, resulting in meaningful improvements in clinical outcomes for patients in a cost effective manner. Monies saved should be redirected into further developing orthogeriatric services.

Abstract Background Older patients post hip fracture benefit from specialist orthogeriatric care. Best practice tariffs incentivising compliance with the Irish Hip Fracture Standards (IHFS) have been introduced in Ireland(1). We compared levels of compliance to IHFS before and after introduction of a dedicated orthogeriatric service in a tertiary referral hospital. We also hypothesized that improved continuity of care by regular orthogeriatric review would result in less general medical consults to medical teams. We looked at the number of inpatient consults sent for each time period and compared the number of general medical consults sought by orthopaedic teams for similar time periods. Methods Data was prospectively collected on all hip fracture patients seen by the orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb2018. Results Similar numbers of patients were seen in each time period (n=146 v n=139) with similar age profiles (81.8 vs 79.6 years). Improvements were seen in all of the six IHFS. The most significant improvements were an increase from 31.2% to 96.5% in the proportion of patients seen by a Geriatrician, and an increase from 7.4% to 98.5% in those who had a formal falls assessment. Fewer patients required medical team consults after the service began (32.2% vs 46.8%, p=0.016). The resultant total number of consults sent fell from 120 consults to 59 consults. Conclusion Introduction of an orthogeriatric service has substantially improved compliance with IHFS. The reduction in the number of medical consults requested by orthopaedic teams reflects the improved quality and continuity of care for these patients.

Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to try and treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix-associated stem cell transplantation (MAST) is one such treatment described for larger lesions > 15 mm2 or failed alternative therapies. This cohort study describes a 3 year review of the outcomes of talar lesions treated with MAST.

Objective: This case series describes four cases with a similar mechanism of injury: crush injuries to the foot from hydraulic presses/trailers. The aim of the study was to review a specific cohort of pneumatic compression injuries of the foot in terms of their soft-tissue component, and in particular relating to the burst lacerations.Method: The mechanism and patterns of injury were reviewed to identify common features in a case series of four crush injuries to the foot which presented to the Emergency Department of University Hospital Galway over a period of 6months between January and July 2017.Results: There were four cases of high-energy crush injuries to the feet seen in involved farmers (mean age 55). The cases presented with similar soft-tissue injuries, despite having quite varied bony injuries. All patients had lacerations of the webbed spaces, which is likely due to extrusion of the interosseous muscles as they are flattened. Three patients had lacerations along the medial side of their foot extending transversely across the plantar surface.Conclusion: A common pattern of soft-tissue injury was present in these cases. We feel the term burst laceration is an appropriate term for describing this pattern. Burst lacerations are a marker of high-energy crush injuries and should alert surgeons to the severe soft-tissue injury that likely overlies the more obvious fracture. The importance of soft-tissue management in high-energy lower limb injury cannot be overstated. We feel the presence of burst lacerations to the foot should alert the surgeon to a high-energy crush-injury type mechanism of injury, and guide both soft-issue and bony management to optimize patient outcomes.