Following surgery to treat major trauma-related fractures, deep wound infection rates are high. It is not known if negative pressure wound therapy can reduce infection rates in this setting. OBJECTIVE To assess outcomes in patients who have incisions resulting from surgery for lower limb fractures related to major trauma and were treated with either incisional negative pressure wound therapy or standard wound dressing. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial conducted at 24 trauma hospitals representing the UK Major Trauma Network that included 1548 patients aged 16 years or older who underwent surgery for a lower limb fracture caused by major trauma from

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Introduction Fractures are a common reason for admission to hospital around the world. Varying incidences have been reported but these are mainly based on small studies from individual centres. The aim of our study was to analyse fracture admissions in England over a ten-year period. Methods Data were collated from the Hospital Episodes Statistics database. Since 2004, data have been collected for all admitted patients in England using the International Classification of Diseases codes for the primary diagnosis. Data were analysed for the ten-year period between 2004–2005 and 2013–2014. Results There were 2,489,052 fracture admissions in England over the 10-year study period. The risk of admission for fracture was 47.84 per 10,000 population. The rate of fracture admission has remained stable. Hip fractures were the most common fracture requiring hospitalisation (n=641,263), followed by distal radius fractures (n=406,313), ankle fractures (n=332,617) and hand fractures (n=244,013). Hip fractures accounted for 58% of hospital bed days, ankle fractures for 10%, and femoral shaft fractures and subtrochanteric femoral fractures for 5% each. The number of bed days per year for hip fractures has reduced from 1,549,939 bed days in 2004–2005 to 1,319,642 in 2013–2014. Conclusions This study provides an updated picture of the incidence of fractures that required hospital admission over a ten-year period in England. It may be used as a platform from which the effect of modern patient treatment pathways can be monitored.

Varying surgical techniques, patient groups and results have been described regards the surgical treatment of post traumatic flexion contracture of the elbow. We present our experience using the limited lateral approach on patients with carefully defined contracture types.Surgical release of post-traumatic flexion contracture of the elbow was performed in 23 patients via a limited lateral approach. All patients had an established flexion contracture with significant functional deficit. Contracture types were classified as either extrinsic if the contracture was not associated with damage to the joint surface or as intrinsic if it was.Overall, the mean pre-operative deformity was 55 degrees (95%CI 48 -61) which was corrected at the time of surgery to 17 degrees (95%CI 12 -22). At short-term follow-up (7.5 months) the mean residual deformity was 25 degrees (95%CI 19 -30) and at medium-term follow-up (43 months) it was 32 degrees (95%CI 25 -39). This deformity correction was significant (p < 0.01). One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve, which had resolved at six weeks. Sixteen patients had an extrinsic contracture and seven an intrinsic. Although all patients were satisfied with the results of their surgery, patients with an extrinsic contracture had significantly (p = 0.02) better results than those with an intrinsic contracture. (28 degrees compared to 48 degrees at medium term follow up).Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe technique, which reliably improves extension especially for extrinsic contractures. In this series all patients with an extrinsic contracture regained a functional range of movement and were satisfied with their surgery.