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Biomedical subjects

C G Moran

Publications and source records attributed to C G Moran.

At least 19 recordsLinked to original sources
PubMed2006

Mortality and causes of death among patients with isolated limb and pelvic fractures.

Between May 2001 and May 2005, all 8834 adults admitted to our hospital with fractures to the limbs and pelvis were prospectively entered onto a database. Information was cross-referenced with the Office of National Statistics, and all patients who died during the study period were identified. Mortality rates were adjusted for age, gender and type of injury and cause of death was identified from hospital records. Neck of femur fractures accounted for 32% of admissions. Younger patients were more likely to be male and older patients more likely to be female. Overall 30-day and 1-year mortalities were 4.5 and 13%, respectively. Increased mortality was associated with age, male gender and fractures of the femur or pelvis.

Adult↗
PubMed2006

Mortality and serum urea and electrolytes on admission for hip fracture patients.

OBJECTIVE: To assess the relationship between pre-operative serum urea and electrolyte concentrations and mortality in patients with hip fractures requiring surgery. METHODS: A prospective observational study of 2963 consecutive patients admitted to a single trauma unit with a hip fracture, treated operatively. RESULTS: The 30-day mortality for patients with low and normal urea concentrations was 6.9%. The 30-day mortality for patients with raised urea concentrations was almost double (11.5%). A raised admission serum urea concentration was an independent predictor for mortality at 30 days, 90 days, 1 year and 2 years. Mortality was significantly increased in patients admitted with: raised or low serum sodium, raised serum potassium and raised serum creatinine. CONCLUSION: Mortality is high following hip fracture. Patients admitted with a raised serum urea are at increased risk of death at all time intervals analysed up to and including 2 years. This group of patients may require a separate care pathway that provides more intensive management of fluid and electrolyte balance.

Adolescent↗
PubMed2005

Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study.

OBJECTIVES: To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality. DESIGN: Prospective observational cohort study. SETTING: University teaching hospital. PARTICIPANTS: 2448 consecutive patients admitted with an acute hip fracture over a four year period. We excluded 358 patients: all those aged < 60; those with periprosthetic fractures, pathological fractures, and fractures treated without surgery; and patients who died before surgery. INTERVENTIONS: Routine care for hip fractures. MAIN OUTCOME MEASURES: Postoperative complications and mortality at 30 days and one year. RESULTS: Mortality was 9.6% at 30 days and 33% at one year. The most common postoperative complications were chest infection (9%) and heart failure (5%). In patients who developed postoperative heart failure mortality was 65% at 30 days (hazard ratio 16.1, 95% confidence interval 12.2 to 21.3). Of these patients, 92% were dead by one year (11.3, 9.1 to 14.0). In patients who developed a postoperative chest infection mortality at 30 days was 43% (8.5, 6.6 to 11.1). Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3 to 2.5), and malignancy (1.5, 1.01 to 2.3). CONCLUSIONS: In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor. Chest infection and heart failure are the most common postoperative complications and lead to increased mortality. These groups offer a clear target for specialist medical assessment.

Age Distribution↗
PubMed2005

The financial cost of treating polytrauma: implications for tertiary referral centres in the United Kingdom.

This observational study was designed to evaluate the financial cost and resources needed to treat a polytrauma patient at a tertiary care centre in the United Kingdom. Sixty-nine patients, from outside the normal hospital catchment area, were referred to a University Hospital and treated for polytrauma (injury severity score>15). Fifty-one patients had head injuries in addition to other injuries. Fourteen patients died in hospital. Forty-seven patients spent 316 ITU days with a total of 832 hospital days. One hundred and ninety-six operating hours were used for their surgical treatment and only 13 patients required neurosurgical intervention. There were 580 radiological and 2967 blood investigations. The total cost of treating these patients was 974,874 pounds. The money received by the hospital from the respective primary care trusts was an average of 1500 pounds per patient for the full treatment including follow up. Thus, the fiscal deficit was 871,375 pounds. This study indicates that the financial accounting for complex cases is antiquated and inaccurate within the NHS. Tertiary referral centres receive only 10% of the appropriate money for treatment of polytrauma patients. The number of patients is relatively small, but their impact on the local services is very high.

Accounting↗
PubMed2005

POSSUM scoring for patients with fractured neck of femur.

BACKGROUND: POSSUM scoring is validated as an audit tool in general and orthopaedic surgery. It is also used for preoperative triage to assess perioperative risk. However its ability to predict mortality in specific surgical subgroups, such as patients with fractured neck of the femur, has not been studied. This study assessed the predictive capability of POSSUM for 30-day mortality after surgery for fractured neck of femur. METHODS: A cohort study was conducted in Queen's Medical Centre, Nottingham over a period of nearly 2 yr. Complete data from 1164 patients were analysed to compare the mortality predicted by POSSUM and the observed mortality. POSSUM risk of death was calculated using the original POSSUM equation, with modifications to the operative score appropriate for orthopaedic surgery. RESULTS: POSSUM predicted 181 (15.6%) deaths and the observed mortality was 119 (10.2%). The area under the receiver operating characteristic curve was 0.62, indicating poor performance by the POSSUM equation. CONCLUSION: POSSUM overpredicts mortality in hip fracture patients. It should be used with caution whether as an audit tool or for preoperative triage.

Adult↗
PubMed2004

Mortality following surgery for undisplaced intracapsular hip fractures.

PURPOSE: The aim of the study was to evaluate the mortality following the operative treatment of undisplaced subcapital fracture of the hip by internal fixation (with three lag screws) or hemiarthroplasty. METHODS: A prospective audit of all patients admitted with hip fracture was undertaken at the university hospital in Nottingham. An independent research assistant collected data on a standardised questionnaire. Mortality was calculated from data received from National office of Statistics allowing 100% 1-year follow up for mortality statistics. RESULTS: One hundred and sixty patients were admitted with undisplaced intracapsular fracture of the hip. Twenty-one patients had non-operative management and were excluded from the results. One hundred and thirty-nine patients had surgical treatment. Mean age of patients was 78 years. Twenty-nine patients had hemiarthroplasty and 110 patients underwent internal fixation of their fractures. There was no significant difference between the two groups for age, sex, mobility, residential status, co-morbidity and cognitive state. There was a significant difference in mortality between the two operated groups at 1 month and 1 year after the operation. Six patients (21%) died after hemiarthroplasty in the first month while there were only two (2%) deaths in the internal fixation group (P < 0.001). At 1 year from operation, 11 patients (38%) from the hemiarthroplasty group and 17 patients (16%) from the internal fixation group died (P = 0.0072). The re-operation rate within 1 year was higher for the internal fixation group (n = 8; 7.2%) than the hemiarthroplasty group (n = 1; 3%). CONCLUSIONS: There is significant increase in mortality when undisplaced intracapsular hip fractures are treated by hemiarthroplasty as compared to internal fixation and we would not recommend it for these fractures.

Aged↗
PubMed2002

Closed reduction of colles fractures: comparison of manual manipulation and finger-trap traction: a prospective, randomized study.

BACKGROUND: An optimal outcome of closed treatment of a Colles fracture may depend on accurate reduction and adequate immobilization. It has been suggested that the use of finger-trap traction results in a better reduction and a lower rate of redisplacement than manual manipulation does, but to our knowledge these concepts have never been evaluated scientifically. We compared these two methods in a prospective, randomized controlled trial. METHODS: Two hundred and twenty-three patients with 225 displaced Colles-type fractures were randomized to treatment with closed reduction with either finger-trap traction (112 patients) or manual manipulation (111 patients). The fractures were assessed radiographically by measurement of the radial angle, dorsal tilt, and radial shortening before reduction, immediately after reduction, and at one and five weeks after reduction. RESULTS: The groups were comparable with regard to age, sex, side of injury, fracture grade, and amount of displacement at presentation. No significant differences were found between the alignment of the fractures in the two treatment groups at any time. With dorsal tilt of <10 degrees and radial shortening of <5 mm considered acceptable, the two techniques both produced an 87% rate of satisfactory reductions. However, the percentages of fractures in an acceptable alignment were only 57% and 50% at one week after finger-trap traction and manual manipulation, respectively, and only 27% and 32% at five weeks. The failure rates did not differ significantly between the two groups. CONCLUSIONS: The two methods of fracture reduction did not differ with regard to the eventual position of the fracture or the rate of failure. Although closed reduction was successful for the majority of fractures, most redisplaced substantially during the period of cast immobilization.

Adult↗
PubMed2001

Internal fixation of ankle fractures in the very elderly.

The management of ankle fracture in the elderly remains controversial. A review of the early results of open reduction and internal fixation (ORIF) in 74 patients over the age of 70 years (average 76 years) was undertaken to identify the early complications, length of stay, return to pre-injury mobility and residential status. This revealed 1% deep infection, 9% delayed wound healing, 5% malunion, and 3% mortality. In 12% of patients, soft bone and comminution precluded fixation of one malleolus. The average length of stay for patients who walked with Zimmer frame (116+/-65 days) before injury was significantly longer than those who walked independently or with sticks (19+/-15 days; P<0.01). The inability of the patients to weight-bear early led to lengthy hospital stays and difficult socio-economic problems. However, the majority (85%) of patients regained their pre-injury mobility and residential status. We conclude that ORIF of ankle fractures in the elderly carries a significant risk of wound edge necrosis with delayed wound healing but the incidence of deep infection is relatively low. Poor bone quality presents technical difficulties but the majority of patients can expect good outcome.

Aged↗
PubMed2001

Cardiac output during hemiarthroplasty of the hip. A prospective, controlled trial of cemented and uncemented prostheses.

In a prospective, controlled study, we measured the effect on cardiac output of the introduction of methylmethacrylate during hemiarthroplasty for displaced fractures of the femoral neck. We treated 20 elderly patients who were similar in age, height, weight and preoperative left ventricular function with either cemented or uncemented hemiarthroplasty. Using a transoesophageal Doppler probe, we measured cardiac output before incision and at six stages of the procedure: during the surgical approach, reaming and lavage of the femoral canal, the introduction of cement, the insertion of the prosthesis, and in reduction and closure. We found that before the cement was introduced, there was no difference in stroke volume or cardiac output (p > 0.25). Cementation produced a transient but significant reduction in cardiac output of 33% (p < 0.01) and a reduction in stroke volume of 44% (p < 0.02). The introduction of cement did not affect the heart rate or mean arterial pressure. There was no significant difference in cardiac function on insertion of the prosthesis. Standard non-invasive haemodynamic monitoring did not detect the cardiovascular changes which may account for the sudden deaths that sometimes occur during cemented hemiarthroplasty. The fall in stroke volume and cardiac output may be caused by embolism occurring during cementation, but there was no similar fall during reaming or insertion of the prosthesis.

Aged↗
PubMed1999

The outcome following major trauma in the elderly. Predictors of survival.

OBJECTIVES: To assess the reliability of the predicted probability of survival calculated using TRISS methodology by the UK Trauma Network for elderly patients. METHOD: Analysis of 100 consecutive trauma patients 65 years and over, prospectively entered into the UK Trauma Network database from a single centre. The probability of survival (Ps) was calculated from the UK Trauma database and retrospectively related to survival, premorbid medical condition and mobility. RESULTS: Of 100 patients, 16 died and 84 survived. Eleven of the 16 who died and 12 of the survivors had pre-existing medical disease (ASA grade III-V) and social dependency suggesting a poor outcome, these factors being significantly associated with mortality (P < 0.005). The mean Ps for the 11 with severe medical disease who died was 0.85 (+/- 0.07) with a mean age 85 (+/- 3.5). The remaining five patients who died suffered high energy injuries, had a mean age of 70 (+/- 4.8) and a low probability of survival (Ps 0.40 +/- 0.24). The median pre-injury mobility score was 8 in patients who survived and 4.5 in those who died. Mobility score < 5 was associated with an increased mortality following admission from Trauma (P < 0.05). CONCLUSIONS: There is a significant association between severe preexisting medical disease (ASA III-V) and death during admission for trauma. The Ps score is unrealistically high in this group of patients. A simple mobility score correlates well with outcome in this group.

Activities of Daily Living↗
PubMed1999

Health outcome after total knee replacement in the very elderly.

Between 1992 and 1994 we performed a prospective study of the effect of total knee replacement (TKR) on the health status of 119 patients over the age of 80 years who had had a primary unilateral TKR. The Nottingham Health Profile was used to assess this before and at three and 12 months after operation. We found a significant improvement in the scores for pain, emotional reaction, sleep and physical mobility at three months. After 12 months, the scores for pain and sleep were well maintained. The other factors had deteriorated slightly but remained better than before operation. Our findings show that TKR leads to a significant improvement in the general health status of the very elderly.

Aged↗
PubMed1998

Actions of endothelin-1, 2, and 3 in the microvasculature of bone.

Endothelins have recently been associated with hypoxia-related vascular smooth-muscle constriction and with the so-called no-reflow phenomenon following reperfusion. Their action is tissue dependent. The role of endothelins on vascular smooth muscle in bone is unknown. An ex vivo perfusion model was used to investigate the effects of the three different endothelins on the vascular resistance in the canine tibia. Endothelin-1 and endothelin-2 had molar potencies similar to that of norepinephrine, whereas endothelin-3 was less potent. Tachyphylaxis to the same dose of endothelin-1 did not occur. The calcium channel blocker, diltiazem, attenuated (45% reduction) the vasoconstrictor responses to norepinephrine (p < 0.005) but had a smaller effect (24% reduction) on the responses to endothelin (p < 0.025). Vascular smooth muscle in bone appears to have endothelin receptors that are similar to those in other organs.

Animals↗
PubMed1998

Combining the clinical signs improves diagnosis of scaphoid fractures. A prospective study with follow-up.

This is a prospective study evaluating the efficacy of four clinical signs believed to be useful in the diagnosis of scaphoid fracture. Two hundred and fifteen consecutive patients with suspected scaphoid fracture were examined on two separate occasions to evaluate tenderness in the anatomical snuff box (ASB), tenderness over the scaphoid tubercle (ST), pain on longitudinal compression of the thumb (LC) and the range of thumb movement (TM). At the initial examination ASB, ST and LC were all 100% sensitive for detecting scaphoid fracture with specificities of 9%, 30% and 48% respectively. These clinical signs used in combination, within the first 24 hours following injury, produced 100% sensitivity and an improvement in the specificity to 74%. TM had 69% sensitivity and 66% specificity. Our results suggest that these clinical signs are inadequate indicators of scaphoid fracture when used alone and should be combined to achieve a more accurate clinical diagnosis.

Adolescent↗