Sylvester O'Halloran Surgical Scientific Meeting - IJMS | Irish Journal ...

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SESSION FIVE ONE
SYLVESTER O’HALLORAN SURGICAL SCIENTIFIC MEETING • 4 - 5 MARCH 2005 • JEAN MONNET THEATRE, UNIVERSITY OF LIMERICK
SYLVESTER O’HALLORAN SURGICAL SCIENTIFIC MEETING • 4 - 5 MARCH 2005 • JEAN MONNET THEATRE, UNIVERSITY OF LIMERICK
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SESSION
SESSION FIVE ONE
47 Plavix - panacea or poison P McKenna, PC Looi,
PLAVIX (clopidogrel bisulfate) is an
inhibitor of platelet aggregation
acting by direct inhibition of
adenosine diphosphate.
Its role in patients with hip fractures has to
date not been assessed. We retrospectively
reviewed all hip fracture patients admitted
to our unit over a two-year period, all of
whom were on Plavix, on admission. A control
group of patients who also had hip fractures,
but who were not on Plavix was analysed.
We compared pre-op ASA scores, Age, Time
to surgery, Haemoglobin, Pre- and post-op
mobility status, complication rates, Mortality
rates. We analysed 20 patients in the Plavix
group, and compared them with an age,
sex and ASA score matched group with hip
fractures. The mean age in the Plavix group
was 82.2 years (range 72-92), control group
81yrs (range 73-90). The Mean pre-op ASA
score, Plavix group 3.55 (range 2-5), control
group 2.9 (range 2-5). Time to surgery was 7.2
days in the Plavix group, there were two preop
mortalities in this group. Time to surgery
in the control group was 2.5 days, with no
pre-op mortality. There were three in-patient
post-op mortalities in the Plavix group, with
none in the control group. Post-operative
Mobility at six weeks and three months
showed no significant difference between
the two groups. This study demonstrates the
increased risk associated with hip fracture in
patients on Plavix. The difference between
the groups may be explained by a slightly
worse pre-op ASA score in the Plavix group,
however the prolonged time to surgery may
significantly worsen the prognosis for
this group.
JA Harty, D O`Farrell,
F Condon
Dept of Orthopaedic
Surgery, Mid-Western
Regional Hospital, Limerick
49 Ring-fencing - bed protection for the patient NT O’Malley, JA Sproule,
Given the high and fluctuating
admission figures in Trauma
Orthopaedics, with priority appropriately
being given to the primary
trauma patient, difficulty arise in
admitting patients for secondary
procedures due to bed shortages.
A ring-fencing policy was initiated whereby
only trauma patients could be admitted to the
ward in an effort to overcome the previously
high cancellation figures (155 in a 12-month
period), and also to maximise efficiency in
accepting referrals from other centres.
Figures were retrospectively accumulated
from admission office files where it was
noted if the patients (a) cancelled themselves,
or (b) were cancelled through lack of beds.
The latter figures were correlated with
prospective data collected on the ward when
infringements of the “ring-fence” policy
occurred, such as when a non-trauma patient
was admitted to the ward.
Overall, there was a 20% decrease in
cancelled secondary trauma admissions
to the ward once the ring-fencing policy
was implemented, in direct comparison
to the previous 12-month period. Of note
the number of “breaks” in the ring-fence
accounted for 30% of cancelled admissions.
In summary, by implementing a bedprotection
policy our unit has decreased
the secondary trauma waiting list by 40%.
This measure, in conjunction with a planned
discharge policy and maximum utilisation of
the day ward will help optimise the Trauma
unit efficiency and throughout.
P Nicholson, JJ Rice,
JP McElwain
Dept of Trauma &
Orthopaedics AMNCH
Tallaght Dublin
48 Blackthorn injuries to the hand JB Lynch, G Sim, JL Kelly,
The blackthorn is one of the
commonest European shrubs. It is
traditionally known as the witches
tree associated with decay, death
and black magic and is frequently
encountered in rural communities
where the toxic extracts may result
in severe hand injuries.
Aim
The aim of this study is to establish the
pattern of blackthorn injuries and to highlight
their severity.
Methods
Fifteen patients were identified over a fiveyear
period. Eleven of these were male.
Penetrating thorn injuries were noted in the
digits in eight cases, palm or dorsum of hand
in six cases and the wrist in one case.
Results
Presentation was delayed from weeks to
months with symptoms progressing slowly,
ranging from pain and swelling to acute
cellulitis and abscess formation. Fourteen
patients underwent wound exploration under
anaesthesia to remove the thorn remnant.
At follow-up residual symptoms such as
persistent joint pain and swelling were
associated with stiffness and reduced range
of movement.
Conclusion
A seemingly innocuous penetrating injury
from the blackthorn may result in longterm
continued disability. Early presentation for
treatment is recommended.
PJ Regan, J McCann
University College
Hospital, Galway
48 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 1 • SUPPLEMENT 1
50 Penalty points: are they working JS Butler, JP Burke,
We conducted a retrospective
study of all acute admissions to the
National Spinal Injuries Centre (NSIC)
over a six-year period (November 1st
1998 to October 31st 2004, n=966)
to analyse the trends in Road Traffic
Accident (RTA) related spinal injuries
following the introduction of a post
penalty points system.
RTA-related spinal injuries accounted for
39.3% of cases admitted to the NSIC over
these six years. 35.2 % of these had some
degree of neurological injury. RTA-related
spinal injuries are significantly more common
in males, with males between the ages of 16
and 24 accounting for 31% of all RTA-related
spinal injury admissions compared with
females of the same age group accounting
for 9.7%. There was an initial reduction of
48.4% in RTA associated NSIC admissions
following the introduction of Penalty Points,
this has not been sustained. The number of
road deaths has decreased since 1997 from
472 to 376 in 2002 however the number of
deaths/1000 collisions has increased over this
period, from 34.74/1000 collisions in 1997 to
39.24/1000 in 2002. The majority of patients
who sustained a spinal injury were drivers,
on a routine journey and on a rural road. The
highest proportion of accidents resulting
in spinal injury occurred during weekends
(64.3% from Fri-Sun) and from midnight to
6am (29.3%).
We conclude the initial reduction in RTArelated
NSIC admissions has not been
sustained and the number of deaths per
thousand collisions continues to rise. Young
male drivers are currently the greatest
at-risk group.
DG Healy, MM Stephens,
F McManus, D McCormack,
JM O’Byrne, AR Poynton
The National Spinal
Injuries Unit, Dept of
Orthopaedic Surgery,
Mater Misericordiae
University Hospital, Dublin
IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 1 • SUPPLEMENT 1 49