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Biomedical subjects

K M Willett

Publications and source records attributed to K M Willett.

11 recordsLinked to original sources
PubMed2006

Deep wound infection after proximal femoral fracture: consequences and costs.

The purpose of this study was to assess the impact of deep wound infection after surgery for proximal femoral fracture (PFF) on the patient in terms of mortality and social consequences, and on the National Health Service in terms of financial burden. Sixty-one cases of PFF over a six-year period were complicated with deep surgical wound infection. These cases were compared with a matched control group of 122 patients without infection. Infected cases had greatly increased hospital stay (P<0.001), were 4.5 times less likely to survive to discharge (P=0.002), and if they survived, were three times less likely to return to their original residence (P=0.05). The total cost of treatment per infected case was 24,410 pound sterling compared with 7210 pound sterling for controls (P<0.001). Meticillin-resistant Staphylococcus aureus (MRSA) infection increased admission length and cost compared with non-MRSA infection (P=0.02). Deep wound infection after PFF is a devastating and costly complication for both the patient and the healthcare services. The cost consequences should be considered when allocating resources to trauma services to ensure adequate provision to minimize infection risks and to accommodate treatment costs in this vulnerable group.

Aged↗
PubMed2006

Maintaining standards in surgical training: how effective is the accreditation by the Specialist Advisory Committee in the United Kingdom?

In order to assess the efficacy of inspection and accreditation by the Specialist Advisory Committee for higher surgical training in orthopaedic surgery and trauma, seven training regions with 109 hospitals and 433 Specialist Registrars were studied over a period of two years. There were initial deficiencies in a mean of 14.8% of required standards (10.3% to 19.2%). This improved following completion of the inspection, with a mean residual deficiency in 8.9% (6.5% to 12.7%.) Overall, 84% of standards were checked, 68% of the units improved and training was withdrawn in 4%. Most units (97%) were deficient on initial assessment. Moderately good rectification was achieved but the process of follow-up and collection of data require improvement. There is an imbalance between the setting of standards and their implementation. Any major revision of the process of accreditation by the new Post-graduate Medical Education and Training Board should recognise the importance of assessment of training by direct inspection on site, of the relationship between service and training, and the advantage of defining mandatory and developmental standards.

Accreditation↗
PubMed2002

Failure of fixation of tibial plateau fractures.

OBJECTIVE: To define the failure of fixation in tibial plateau fractures, detect its incidence, and determine the contributing factors. DESIGN: Mail survey and literature review were used to define the fixation failure; this definition was applied to a radiologic review of patients who were treated surgically for tibial plateau fracture at a Level 1 trauma unit for a three-year period from 1993 to 1995. PATIENTS AND SETTING: Forty-two consecutive patients treated surgically at our trauma unit for tibial plateau fractures were studied retrospectively, specifically for loss of fixation. Factors that might affect the fracture fixation were reviewed, including age, mechanism of injury, type of fracture, bone quality, severity of fragmentation, severity of displacement, time to surgery, operating time, fixation method, use of bone graft, postoperative bracing, and mobilization. MAIN OUTCOME MEASURES: The main outcome measure was failure of fixation, by using criteria defined by the result of a mail survey of experts and literature review. RESULTS: Using a strict definition of radiologic failure of fixation, we reported an overall 31 percent rate of failure of fixation: 79 percent in patients older than sixty years compared with 7 percent in younger patients. The statistically significant associations with loss of reduction were age more than sixty years, premature weight bearing, preoperative displacement, fracture fragmentation, and severe osteoporosis. CONCLUSION: It is logical to define failure of fixation using the same measures considered as indications for reduction and fixation. Using these strict criteria, the incidence of radiologic failure was much higher than previous published series. In the elderly this was unacceptably high, and treatment goals should be limited to restoring stability and alignment.

Adult↗
PubMed2001

Operative management of acetabular fractures in Oxford.

We reviewed the epidemiology and complications of 79 patients who had operative treatment for an acetabular fracture undertaken at this hospital, in the first 5 years of a pelvic and acetabular fracture service. The median Injury Severity Score was 18 (range, 9-41). Sixty-five patients (82%) had an important injury of at least one other system. Eighteen patients (23%) had a sciatic nerve injury on presentation. Thirty-seven patients (47%) had a post-operative complication, but this did not affect the outcome in the majority. The re-operation rate was 5%.Seventy-four patients (94%) had clinical and radiological follow-up for a mean of 2.6 years. Fifty-five patients (74%) had a good or excellent result, which was associated with early operation and an anatomical reduction. Poor outcome was associated with delay to surgery, failure to achieve or maintain reduction, and femoral head damage at the time of injury.

Acetabulum↗
PubMed2001

Evaluation of the Oxford protocol for total spinal clearance in the unconscious trauma patient.

BACKGROUND: Prolonged use of spinal precautions in unconscious trauma patients is associated with significant morbidity. The trauma service of the John Radcliffe Hospital uses full-length radiography, computed tomographic scanning, and dynamic screening of the cervical spine to clear the spine at the earliest opportunity. METHODS: The results in 210 consecutive patients were reviewed. Seventy-eight patients underwent dynamic screening of the cervical spine. RESULTS: Five of these patients had a cervical fracture or instability. One patient had demonstrated minor changes only on plain radiography but gross instability on dynamic screening. There were no neurologic sequelae from dynamic screening and no fractures were missed. Collar removal was possible in all but one patient a median 3 days before extubation and 1 day after admission to the intensive care unit. CONCLUSION: Full length spinal radiography and dynamic cervical screening may allow early and safe discontinuation of spinal precautions in the unconscious trauma patient in whom clinical signs are absent or unreliable.

Adolescent↗
PubMed1998

The tension cord plaster: a method of immobilising the swollen elbow.

A method of immobilising the swollen elbow in a child is described. A length of traction cord is used to block extension, whilst a plaster backslab protects the point of the elbow. Constructive dressings in the cubital fossa may be avoided. This minimises the risk of further swelling and allows assessment of circulation in the elbow, forearm and hand without interfering with the integrity of the cast. Should increasing swelling threaten circulation, the traction cord may simply be cut on the ward to allow elbow extension. Use of this plaster is recommended when flexion of the elbow is necessary to maintain reduction of a fracture, such as following reduction of an extension-type supracondylar fracture.

Casts, Surgical↗
PubMed1991

Noise-induced hearing loss in orthopaedic staff.

In the light of EEC proposals on the avoidance of damage to hearing caused by noise, a study was undertaken to determine the risk posed by powered orthopaedic instruments. The noise levels from a number of air-powered and electric tools were measured and analysed and found to exceed the recommended levels. The predicted daily personal noise exposure was calculated and the potential for hearing damage confirmed. Twenty-seven senior orthopaedic staff were then assessed by audiometry; evidence of noise-induced hearing loss was found in half the subjects. The increasing use of powered instruments in elective orthopaedics and fracture fixation may present a significant cumulative risk to the hearing of orthopaedic surgeons and theatre personnel. The use of ear defenders should be promoted, and manufacturers should be encouraged to develop instruments with lower noise emission levels.

Audiometry↗
PubMed1988

The effect of suction drains after total hip replacement.

A prospective study of 120 consecutive total hip replacements showed that deep suction drains produced maximal drainage volumes in the first 24 hours. Their continued presence resulted in minimal further drainage, did not reduce the likelihood of haematoma formation and led in some cases to the spread of skin organisms into the wound.

Hematoma↗