Objectives:To demonstrate the gender distribution in leadership positions and academic promotion of Orthopaedic Trauma Association (OTA) members.Methods:We conducted a cross-sectional examination of the 2020-2021 OTA membership cohort dataset provided by the OTA. Professional and academic information of OTA members at their site of appointment was also abstracted from publicly available online resources. Data included: gender, OTA membership category, OTA leadership position, trauma fellowship completion, trauma practice setting, level of trauma center, percentage of trauma work, year of first practice, academic rank, and university/hospital/institutional leadership role. Statistical analysis included chi-squared, Wilcoxon two-sample, and Fisher exact tests.Results:2608 OTA members were identified; 14.1% were women. Female representation was highest in the Trauma Practice Professional category (67.1%) and significantly lower in the Active category (9.1%) (P < 0.0001). No statistically significant gender differences were observed regarding level of trauma center, percentage of trauma work, or trauma practice setting. In the Active, Clinical and Emeritus categories, men achieved a higher level of academic rank than women at their site of employment (P = 0.003), while more men completed trauma fellowships (P = 0.004) and had been in practice for significantly longer (P < 0.0001). Men held more of the highest leadership positions (eg, Board of Directors) (P = 0.0047) and the greatest number of leadership positions (P = 0.017) within the OTA compared with women.Conclusion:Gender disparity exists within the upper echelon of leadership and academic representation in orthopaedic trauma. Our findings will help inform strategic policies to address gender diversity within the OTA and the broader orthopaedic trauma subspecialty.

Abstract Introduction Due to an increased risk of complications, lateral clavicle fractures are usually managed operatively. Unfortunately, there is no consensus on the optimal method of fixation. Method We assessed practice in our regional trauma unit by retrospectively identifying patients who underwent fixation of a lateral clavicle fracture between 1st August 2014 and 31st July 2019. Data was extracted from electronic care records and imaging systems. Results 44 patients were included, with the following demographics: mean age 26 years, 63.6% male, 65.9% high energy injury, and 68.2% Neer II fracture. The following operations were performed; hook plate fixation (HPF) = 10, locking plate fixation (LPF) = 16, coracoclavicular ligament reconstruction (CCLR) = 12, and LPF + CCLR = 6. Patients having LPF had a significantly larger post-operative coracoclavicular distance (7.6mm vs 13.5mm, p < 0.01), and a trend towards incomplete acromioclavicular joint reduction (50.0% vs 89.3%, p = 0.11). There was a significantly higher re-operation rate after HPF (100% vs 23.5%, p < 0.01). Conclusions In our unit there is no favoured method of fixation of lateral clavicle fractures. When LPF is used, there should be consideration of concomitant CCLR. The high rate of re-operation after HPF must be considered.

BACKGROUND CONTEXT: Concerns have been expressed regarding the safety of rugby. It remains a popular sport. Cycling continues to increase in popularity and is expounded as a good form of exercise.

INTRODUCTION:Spinal metastases secondary to renal cell carcinoma are associated with significant intra-operative blood loss. Our aim was to assess if embolisation reduced the intra-operative blood loss and transfusion requirement. METHODS:We performed a retrospective cohort study of 25 patients undergoing surgery between 2003 and 2011. RESULTS:14 underwent pre-operative embolisation; 11 did not. There was no significant difference in intra-operative blood loss, 1336 ml vs 1492 ml in the non-embolised (p value = 0.116). 43% of embolised patients required an intra operative blood transfusion vs 27% in the non-embolised. CONCLUSION:Our results suggest that not all patients with spinal metastatic renal carcinoma require pre-operative embolisation.

INTRODUCTION:Current hip fractures guidelines recommend surgery within 36 h of admission. The 2011 National Hip Fracture Database (NHFD) report shows our institute has the fewest patients meeting this target (9%). Northern Irelands' exclusion from the "Best Practice Tariff" means no incentive-led treatment or prioritisation of hip fracture patients. METHOD:We performed a systematic review of post-operative results to highlight deficiencies in delivery of patient care. We reviewed 702 patients admitted between September 2009 and April 2012. Patients were prospectively identified and added to our Fracture Outcome and Research Database (FORD). Results were compared to national average values from the NHFD. RESULTS:16.7% of patients met the 36-h target to theatre compared to the UK average of 66%. 81.7% underwent a pre-operative orthogeriatric review. The main reasons for surgical delay were inadequate theatre space (58%) and medically unfit patients (29%). After exclusion of medically unfit patients, medically fit patients were divided into delayed surgery and not delayed categories. Medically fit patients who had delayed surgery had inferior outcomes- longer hospital stay and higher mortality as an inpatient and at 30 days. CONCLUSION:Without a change in funding, Northern Ireland will struggle to compete with the UK mainland and decrease mortality in this patient group.