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Managing periprosthetic fractures – a review of the hub and spoke model

Introduction: Periprosthetic fractures are associated with significant morbidity and mortality. The “hub and spoke model” consists of a central organisation (the hub) and a series of secondary units (the spokes). This study reviews the presentation, management, and outcomes of periprosthetic fractur...

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Autores principales: Mudiganty, Srikanth, Hughes, Luke, Choudry, Qaisar, Bokhari, Awais
Formato: Online Artículo Texto
Lenguaje:English
Publicado: EDP Sciences 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765126/
https://www.ncbi.nlm.nih.gov/pubmed/35040775
http://dx.doi.org/10.1051/sicotj/2022001
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author Mudiganty, Srikanth
Hughes, Luke
Choudry, Qaisar
Bokhari, Awais
author_facet Mudiganty, Srikanth
Hughes, Luke
Choudry, Qaisar
Bokhari, Awais
author_sort Mudiganty, Srikanth
collection PubMed
description Introduction: Periprosthetic fractures are associated with significant morbidity and mortality. The “hub and spoke model” consists of a central organisation (the hub) and a series of secondary units (the spokes). This study reviews the presentation, management, and outcomes of periprosthetic fractures at a large general district hospital, the Royal Blackburn Hospital. Methods: A retrospective data analysis for patients presenting with periprosthetic fractures from a single general district hospital between January 2011 and December 2020. Details recorded were patient demographics, primary arthroplasty procedure, fracture management, ASA grade, morbidity and mortality, and Unified Classification System for Periprosthetic Fractures (UCSPF). Results: With 229 periprosthetic fractures, the number tripled in 2020 that admitted in 2011. The mean age was 78.6 years (range 33–100), 151 were females. Seventy-five percent of the fractures were managed locally, while 25% a referral to the higher specialist centre was sort. Of the 57 referrals, 50 were transferred to the hub, 5 were operated on locally, and 2 were managed non-operatively. Higher-level care transfer resulted in a delayed definitive treatment (4.8 versus 12 days, p = 0.001). About 94.4% of patients treated locally had a favourable outcome versus 92% of patients treated at the hub hospital. Cumulative mortality rates for the two sites were comparable. Discussion: Most of the patients presenting to the local spoke hospital with periprosthetic fractures were managed in house. For this practice to be preserved, there is a need for future planning, such as maintaining an appropriate skill mix at spoke units. Discussion between specialists at the hub and spoke hospitals reduced patient transfer by 14%.
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spelling pubmed-87651262022-02-07 Managing periprosthetic fractures – a review of the hub and spoke model Mudiganty, Srikanth Hughes, Luke Choudry, Qaisar Bokhari, Awais SICOT J Original Article Introduction: Periprosthetic fractures are associated with significant morbidity and mortality. The “hub and spoke model” consists of a central organisation (the hub) and a series of secondary units (the spokes). This study reviews the presentation, management, and outcomes of periprosthetic fractures at a large general district hospital, the Royal Blackburn Hospital. Methods: A retrospective data analysis for patients presenting with periprosthetic fractures from a single general district hospital between January 2011 and December 2020. Details recorded were patient demographics, primary arthroplasty procedure, fracture management, ASA grade, morbidity and mortality, and Unified Classification System for Periprosthetic Fractures (UCSPF). Results: With 229 periprosthetic fractures, the number tripled in 2020 that admitted in 2011. The mean age was 78.6 years (range 33–100), 151 were females. Seventy-five percent of the fractures were managed locally, while 25% a referral to the higher specialist centre was sort. Of the 57 referrals, 50 were transferred to the hub, 5 were operated on locally, and 2 were managed non-operatively. Higher-level care transfer resulted in a delayed definitive treatment (4.8 versus 12 days, p = 0.001). About 94.4% of patients treated locally had a favourable outcome versus 92% of patients treated at the hub hospital. Cumulative mortality rates for the two sites were comparable. Discussion: Most of the patients presenting to the local spoke hospital with periprosthetic fractures were managed in house. For this practice to be preserved, there is a need for future planning, such as maintaining an appropriate skill mix at spoke units. Discussion between specialists at the hub and spoke hospitals reduced patient transfer by 14%. EDP Sciences 2022-01-18 /pmc/articles/PMC8765126/ /pubmed/35040775 http://dx.doi.org/10.1051/sicotj/2022001 Text en © The Authors, published by EDP Sciences, 2022 https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Mudiganty, Srikanth
Hughes, Luke
Choudry, Qaisar
Bokhari, Awais
Managing periprosthetic fractures – a review of the hub and spoke model
title Managing periprosthetic fractures – a review of the hub and spoke model
title_full Managing periprosthetic fractures – a review of the hub and spoke model
title_fullStr Managing periprosthetic fractures – a review of the hub and spoke model
title_full_unstemmed Managing periprosthetic fractures – a review of the hub and spoke model
title_short Managing periprosthetic fractures – a review of the hub and spoke model
title_sort managing periprosthetic fractures – a review of the hub and spoke model
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765126/
https://www.ncbi.nlm.nih.gov/pubmed/35040775
http://dx.doi.org/10.1051/sicotj/2022001
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