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Hip Fractures

A hip fracture could be a break within the upper quarter of the thighbone (thigh) bone. The extent of the break depends on the forces that are concerned. The kind of surgery accustomed treat a hip fracture is based on the bones and soft tissues affected or on the amount of the fracture.

The “hip” could be a ball-and-socket joint. It permits the higher leg to bend and rotate at the pelvis. An injury to the socket, or cotyloid cavity, itself isn’t thought-about a “hip fracture.” Management of fractures to the socket could be a fully completely different thought.

Causes

Hip-Fracture1

Hip fractures most ordinarily occur from a fall or from a right away blow to the facet of the hip. Some medical conditions like pathology, cancer, or stress injuries will weaken the bone and create the hip a lot of liable to breaking. In severe cases, it’s potential for the hip to break the patient just standing on the leg and twisting.

Symptoms

The patient with a hip fracture can have pain over the outer higher thigh or within the groin. There’ll be vital discomfort with any decide to flex or rotate the hip.

If the bone has been weakened by illness (such as a stress injury or cancer), the patient could notice aching within the groin or thigh space for a amount of your time before the break. If the bone is totally broken, the leg could seem to be shorter than the non-injured leg. The patient can usually hold the gashed leg in an exceedingly still position with the foot and knee turned outward (external rotation).

Doctor Examination

Imaging

The diagnosing of a hip fracture is mostly created by an X-ray of the hip and thighbone.

Hip fractures occur at the higher finish of the thigh bone (femur).

In some cases, if the patient falls and complains of hip pain, an incomplete fracture might not be seen on an everyday X-ray. in this case, resonance imaging (MRI) is also suggested. The MRI scan can sometimes show a hidden fracture.

An MRI could establish a hip fracture otherwise incomprehensible on plain X-ray.

If the patient is unable to possess an MRI scan due to an associated medical condition, X-raying (CT) is also obtained instead. X-raying, however, isn’t as sensitive as MRI for seeing hidden hip fractures.

Types of Fractures

In general, there are 3 differing types of hip fractures. The kind of fracture depends on what space of the higher thighbone is concerned.

Intracapsular Fracture

Hip-Fracture2

These fractures occur at the amount of the neck and therefore the head of the thighbone, and are typically at intervals the capsule. The capsule is that the soft-tissue envelope that contains the lubricating and nutrient fluid of the ball-and-socket joint itself.

Intracapsular Fracture

This fracture happens at the amount of the “neck” of the bone and should have loss of blood provide to the bone.

Intertrochanteric Fracture

This happens more down the bone and tends to possess higher blood provide to the fracture items.

Intertrochanteric Fracture

This fracture happens between the neck of the thighbone and a lower bony prominence referred to as the lesser outgrowth. The lesser outgrowth is an attachment purpose for one amongst the main muscles of the hip.

Intertrochanteric fractures typically cross within the space between the lesser outgrowth and therefore the bigger outgrowth. The bigger outgrowth is that the bump you’ll be able to feel underneath the skin on the surface of the hip. It acts as another muscle attachment purpose.

Subtrochanteric Fracture

This fracture happens below the lesser outgrowth, in an exceedingly region that’s between the lesser outgrowth and a locality around 2 1/2 inches below.

Subtrochanteric Fracture

This happens even more down the bone and should be broken into many items.

In more sophisticated cases, the quantity of breakage of the bone will involve quite one amongst these zones. this can be taken into thought once surgical repair is taken into account.

Treatment

Considerations

Once the diagnosing of the hip fracture has been created, the patient’s overall health and medical condition are going to be evaluated. In really rare cases, the patient is also so unwell that surgery wouldn’t be suggested. In these cases, the patient’s overall comfort and level of pain should be weighed against the risks of anaesthesia and surgery.

Most surgeons agree that patients do higher if they’re operated on fairly quickly.

It is, however, vital to insure patients’ safety and maximize their overall medical health before surgery. This might mean taking time to try and do viscus and different diagnostic studies.

Nonsurgical Treatment

Stable fracture. Sure fractures that haven’t stirred (“displaced”) might not need surgery. As a result of there’s a risk that they’ll move shortly, they’re usually fastened.

Patients who may well be thought-about for medical procedure treatment embody individuals who are too unwell to endure any kind of anesthesia and other people who were unable to run before their injury and should are confined to a bed or a chair.

Certain kinds of fractures are also thought-about stable enough to be managed with medical procedure treatment. as a result of there’s some risk that these “stable” fractures could instead prove unstable and displace (change position), the doctor can have to be compelled to follow with periodic X-rays of the world. If patients are confined to bed rest as a part of the management for these fractures, they’re going to have to be compelled to be closely monitored for complications which will occur from prolonged immobilization. These embody infections, bed sores, pneumonia, the formation of blood clots, and biological process wasting.

Surgical Treatment

Before Surgery

Anesthesia for surgery may be either general anaesthesia with a respiration tube or spinal anaesthesia. In terribly rare circumstances, wherever solely many screws are planned for fixation, anaesthesia with significant sedation is thought-about. All patients can receive antibiotics throughout surgery and for the 24-hours later on.

Appropriate blood tests, chest X-rays, electrocardiograms, and water samples are going to be obtained before surgery. Several aged patients could have unknown tract infections that might result in an infection of the hip once surgery.

The surgeon’s call on the way to best fix a fracture are going to be supported at the hip that’s broken and therefore the surgeon’s familiarity with the various systems that are out there to manage these injuries.

Intracapsular Fracture

If the top of the thighbone (“ball”) alone is broken, management are going to be aimed toward fixing the gristle on the ball that has been gashed or displaced. Often with these injuries, the socket, or cotyloid cavity, can also be broken. The doctor can have to be compelled to take this into thought in addition.

These injuries are also approached either from either the front or back of the hip. In some cases, each approach is needed so as to obviously see and fix the gashed bone.

For true intracapsular hip fractures, the doctor could decide either to mend the fracture with individual screws (percutaneous pinning) or one larger screw that slides at intervals the barrel of a plate.

This compression hip screw can permit the fracture to become a lot of stable by having the broken space impact on itself. Sometimes, a secondary screw is also additional for stability.

Repair of an intracapsular fracture with individual screws.

Repair of an intracapsular fracture with one compression hip screw.

If the intracapsular hip fracture is displaced in an exceedingly younger patient, a surgical try are going to be created to scale back, or realign, the fracture through a bigger incision. The fractures are going to be control at the side of either individual screws or with the larger compression hip screw.

In these cases, the bloods provide to the ball, or head of the thighbone, could be broken at the time of injury (avascular necrosis). Although the fracture is realigned and glued into place, the cartilage and underlying supporting bone might not receive adequate blood. Over a amount of your time, this might cause the leg bone head to flatten. once this happens, the joint surface becomes irregular. Ultimately, the ball-and-socket joint could develop a painful inflammatory disease, despite the surgical repair.

Although the fracture is repaired, the blood provide to the “ball” of the thighbone is broken. In the older patient, the prospect that the top of the thighbone is broken during this manner is higher. It’s typically felt that for these displaced fractures, patients can do higher if a number of the elements of the hip are replaced. In some cases, this may mean a replacement of the ball, or head of the thighbone (hemiarthroplasty). In different cases, this may mean the replacement of each the ball and socket, or head of the thighbone and cotyloid cavity (total hip replacement). Hemiarthroplasty could be a kind of hip replacement within which solely the “ball” of the hip is replaced. A total hip replacement replaces each the socket and ball.

Intertrochanteric Fracture

Repair of an intertrochanteric fracture with an intramedullary nail. The nail is within the hollow cavity of the thighbone (thighbone) instead of on the facet of it (as with a plate).

Most intertrochanteric fractures are managed with either a compression hip screw or an intramedullary nail, that conjointly permits for impaction at the fracture website.

The compression hip screw is fastened to the outer facet of the bone with bone screws and incorporates a massive secondary screw (lag screw) that’s placed through the plate into the neck and head of the hip (see compression hip screw figure above). The planning of the device permits for impaction and compression at the fracture site. This might increase the steadiness of the area and promote healing.

The intramedullary nail is placed directly into the marrow canal of the bone through a gap created at the highest of the bigger outgrowth. A lag bolt is then placed through the nail and up into the neck and head of the hip. Like the compression hip screw, sliding of the lag bolt and impaction of the fracture occur. There aren’t any definitive studies to point out that one device is superior to another. The choice on that to use is predicated on the surgeon’s preference and knowledge.

Subtrochanteric Fracture

At the subtrochanteric level, most fractures are managed with a protracted intramedullary nail at the side of an outsized lag bolt or they’re managed with screws that capture the neck and head of the thighbone or the world straight off beneath it, if it’s remained intact.

Repair of subtrochanteric fracture with a protracted intramedullary nail.

Interlocking screws at the tip of the nail create the fixation safer.

In order to stay the bones from rotating round the nail or from shortening (“telescoping”) on the nail, further screws is also placed at the lower finish of the nail within the space of the knee. These are referred to as interlocking screws.

In most cases, the doctor could prefer to use a plate instead of a nail. The plate can have screws that get into the bone from the lateral, or outer, side of the thighbone. one massive screw goes into the neck and therefore the head of the thighbone and seems the same as the compression hip screw, however at a distinct angle. Secondary screws ar then placed through the plate into the bone to carry the fracture in situ. A lockup plate is also used for tougher to treat fractures.

After Surgery

Patients is also discharged from the hospital to their home or notice that a keep in an exceedingly rehabilitation facility is critical to help them in return their ability to run.

Rehabilitation

Patients are also inspired to induce out of bed on the day following surgery with the help of a healer. The quantity of weight that’s allowed to be placed on the gashed leg are going to be determined by the doctor and is mostly a operate of the kind of fracture and repair (fixation).

The medical expert can work with the patient to assist regain strength and therefore the ability to run. This method could take up to 3 months.

Medical Care

Occasionally, an introduction is also needed once surgery, however long run antibiotics are typically not necessary. Most patients are going to be placed on drugs to thin their blood to scale back the possibilities of developing blood clots for up to six weeks. These medicines are also within the kind of pills or injections. Elastic compression stockings or expansive compression boots can also be used.

Follow Up Care

During the appointments that occur once surgery, the doctor can wish to envision the wound, take away sutures, follow the healing method exploitation X-rays, and order further therapy, if necessary. Following hip fracture surgery, most patients can regain abundant, if not all, of the quality and independence they’d before the injury.

Hip Fracture

A hip fracture is another term for a broken hip. it’s a typical injury that principally affects older ladies who typically have underlying osteoporosis. Your hip can break in several places. A hip fracture is intracapsular (within the joint capsule) or extracapsular (outside the joint capsule). The majorities who have a hip fracture would like an operation to repair the break within the bone. Whether or not your fracture is intracapsular or extracapsular can confirm the precise treatment that the orthopedical doctor suggests. It’s necessary that any underlying osteoporosis be treated when a hip fracture.

Some anatomy of your hip

Your articulatio coxae are known as a ball and socket joint. The ball (head) of your thighbone (your thigh bone) fits into the socket of your girdle bone to create your articulatio coxae. This socket is termed the socket. There’s a robust however joint capsule that surrounds the articulatio coxae. It facilitates to offer stability to the joint and conjointly produces a fluid referred to as synovial fluid to offer lubrication and help joint movement.

What is a hip fracture?

A hip fracture is another term for a broken hip. Your hip can break in several places. A hip fracture is intracapsular (the bone inside the joint capsule breaks) or extracapsular (the bone outside the joint capsule breaks). The location of your hip fracture will determine the treatment that the orthopedical doctor suggests (see below).

Your hip fracture may be displaced or non-displaced. A fracture could be a fracture wherever the broken bones have moved out of their normal position. If the bone fragments have affected, they have to be reinstate (reduced) into their normal alignment. During a non-displaced fracture, the bone fragments, even supposing they’re broken, are still aligned in their normal position.

How common could be a hip fracture?

A hip fracture could be a quite common injury that affects principally older individuals. it’s one among the foremost common reasons for being admitted to an orthopedical (bone) ward in a hospital. Around 75,000 hip fractures are treated annually within the uk. However, given the UK’s ageing population, this variety is expected to double by 2050.

About eight in ten folks that fracture a hip are ladies. The common age of somebody who fractures their hip is eighty years.

What causes a hip fracture?

For older individuals, a hip fracture happens when a fall, typically simply a fall from standing. If you have got osteoporosis you’re more seemingly to fracture your hip after you fall. Osteoporosis is the leading reason for hip fracture. Osteoporosis means you have got lost some bone material. Your bones subsided dense and more alveolate. This makes them a lot of liable to breaking.

There are a variety of reasons why an older person might fall. It should simply be an easy trip over a loose furnishings or an item of furnishings. However, typically there is also a medical reason for a fall. As an example, low vital sign, a rhythm abnormality, a faint, etc. If you fracture your hip, the doctors can typically attempt to rummage around for any reason why you will have fallen. Any underlying downside may have to be treated yet.

A hip fracture may occur in younger individuals. In these cases, it’s a lot of seemingly to be caused by trauma like an automotive crash or a fall from a big height.

What are the symptoms of a hip fracture?

If you fracture your hip you may be during a heap of pain round the contused hip. You may be unable to maneuver your hip, stand or walk. You will conjointly notice that the affected leg appearance shorter and is turned outward compared to your alternative leg.

What ought to I do if I’m involved that I even have a hip fracture?

If you think that that you simply might have broken your hip, you would like to induce to hospital as shortly as attainable. A friend, relative or neighbor is also able to facilitate. While expecting the car to arrive, don’t attempt to move. You must conjointly attempt to keep warm; covering up with a blanket is also useful. Don’t eat or drink something whereas you’re expecting the car to arrive. Once the car arrives, you will run some pain relief for the journey. You may be carried on a stretcher to the car and brought to hospital.

What happens once I reach hospital?

You will typically be seen in the Accident and Emergency department and assessed quickly. You will run some additional pain relief medication, if needed, and sent for an X-ray to look at your hip. If you’re dehydrated, you will run some blood vessel fluids (fluids via a drip into one amongst your veins). You’ll then typically be seen by an orthopedic doctor who will decide the most effective thanks to treat your hip fracture (see below). Typically you will even be seen by another specialist if you have got pre-existing health issues.

Occasionally, a hip fracture can’t be seen on a customary X-ray. If you have got hip pain and have fallen, the doctors might want to make sure that you simply haven’t broken your hip. You must then be offered a resonance imaging (MRI) scan, which supplies a lot of elaborate data concerning the articulatio coxae and soft tissue around it. If an mri scan isn’t appropriate for you or if it’s not obtainable inside twenty four hours, then a unique variety of scan referred to as computerized tomography (CT) should be offered.

What is the treatment for a hip fracture?

Most people who have a hip fracture would like surgery to repair the break within the bone. The kind of surgery that you simply have will rely on wherever you have got broken your hip bone (whether you have got an intracapsular or extracapsular fracture) and conjointly any underlying health issues that you simply might have.

You must discuss the choices out there with the doctor who is performing arts your operation. Current tips from the National Institute for Health and Clinical Excellence (NICE) advocate that surgery ought to be performed, if attainable, on the day of, or the day when, admission. The rules conjointly advocate that adequate pain relief before and when surgery is important. However, non-steroidal medicament medicines aren’t suggested for pain relief for those who have a hip fracture.

Treating a hip fracture

Hip fractures are nearly always treated with surgery. Concerning half all cases need a partial or complete hip replacement (a surgery to interchange the enarthrosis with a synthetic version). The remainder would like surgery to mend the fracture with plates and screws or rods.

Recovering from surgery

After surgery, a rehabilitation programme that includesphysiotherapy are going to be accustomed facilitate recovery. this may involve totally different care professionals, as well as activity therapists and physiotherapists.

Rehabilitation is vital for a prospering recovery. There are dedicated rehabilitation units, known as geriatric orthopedic rehabilitation units (GORU), for older individuals with orthopedic conditions.

The right rehabilitation programme might facilitate older individuals retreat to on their feet when surgery. Despite this, when a hip fracture some older individuals may:

•           not regain the power to maneuver

•           no longer be able to live severally in their own homes

The National osteoporosis Society estimates that around one,150 individuals die each month within the UK as a results of hip fractures.

Intracapsular hip fractures

•           Non-displaced fractures – typically, if you have got a non-displaced intracapsular hip fracture, you may have an operation to affix along and hold in situ the broken bone fragments. This is often referred to as internal fixation. Numerous devices are used to give the fixation, as well as screws, nails, plates and rods. Internal fixation like this {allows} faster healing of the broken hip bone and typically allows you to induce up and mobile a lot of quickly.

Sometimes, a non-displaced intracapsular fracture is treated cautiously. This suggests that no operation is done and your hip bone is left to heal naturally. However, if this is often the case, your keep in hospital tends to be longer. There’s conjointly the chance that the bone fragments will move so the hip fracture becomes displaced. This treatment is typically reserved for those who have severe underlying health issues or who are terribly frail and wouldn’t be able to undergo an operation.

•           Displaced fractures – if you have got a displaced intracapsular hip fracture, the bone fragments have to be compelled to be re-aligned. They’ll then be fastened in situ throughout an operation using internal fixation as represented above. Sometimes, a hip replacement is employed to treat a hip fracture. Hip replacement is additionally referred to as hip operation.

Throughout a hip replacement, the doctor removes elements of the bones that form up your hip and replaces them with artificial hip elements, conjointly referred to as prostheses. A complete hip operation is wherever either side of the articulatio coxae are replaced (the ball, or head, of the thighbone and therefore the acetabulum socket). A hemiarthroplasty is wherever solely the top of the thighbone is replaced by a synthetic half.

If you have already got some articulatio coxae illness – as an example, arthritis – and you’re moderately active and otherwise well, a complete hip replacement is also a good choice to treat a displaced intracapsular hip fracture.

Extracapsular hip fractures

An operation is additionally required to treat extracapsular hip fractures. A special screw referred to as a slippery hip screw is typically fitted to carry the bone fragments in situ. Typically a nail (called an intramedullary nail) is employed instead.

Types of anaesthetic utilized in hip fracture surgery

Spinal or epidural is usually used throughout hip fracture surgery. A anesthetic is once an area anaesthetic drug is injected through a needle into the little of your back to numb the nerves from your waist downward for 2 to a few hours. an epidural anaesthetic is wherever a small plastic tube (an epidural catheter) is passed through a needle into the little of your back.

Through this tube, you’re given local and pain-relieving medication. Again, it produces symptom in your lower body however it is flat-top up so the consequences last longer than with an anesthetic.

What happens when surgery for a hip fracture?

After surgery you may typically be taken from the operating room to an orthopedic ward. You must run pain relief pro re nata. Oxygen therapy (via a facemask or nasal cannulae) is typically required. A drip to offer you blood vessel fluids also will be needed by most people.

After surgery, you must be offered rehabilitation treatment, as well as therapy, that ought to begin on the day when surgery. A physical therapist ought to assess you and supply mobilisation (exercises to assist promote strength and recovery), unless there’s a medical or surgical reason to not.

You must be offered mobilisation a minimum of once every day and have regular therapy reviews. You will even be seen by an activity expert to assist you reach your most level of perform and independence when your hip fracture. They’ll facilitate with any diversifications that will be required around your home to permit you to come back home safely.

Some hospitals have specialised geriatric-orthopaedic rehabilitation wards that ar created to assist older people that have sustained injuries together with hip fractures.

Treatment of any underlying osteoporosis

If you’re an older one that has broken your hip, it’s common for there to be underlying osteoporosis. Reckoning on your age, you will be referred for a special dual-energy X-ray absorptiometry (DEXA) bone scan to seem for any proof of bone dilution and pathology. However, girls over the age of eighty most have a degree of osteoporosis, so this bone scan is typically solely prompt for folks below the age of seventy five.

Treatment of osteoporosis is usually with drugs within the bisphosphonate cluster of medicines. These are typically prescribed with dietary supplements of calcium and cholecarciferol.

Are there any attainable complications when a hip fracture?

Complications that will occur in some folks following a hip fracture include:

•           Infection – you will run some antibiotics to do to forestall infection (such as wound infection) when surgery to treat a hip fracture. Respiratory disease is another infection which will occur when a hip fracture.

•           Deep vein occlusion (DVT) – a DVT could be a blood during a vein, typically a leg vein. It is caused by immobility. As you may be a lot of immobile when a hip fracture, you’re at raised risk of developing a DVT. For this reason, you may conjointly typically run some medication to assist forestall DVT when you have got a hip fracture. See separate leaflet referred to as ‘Deep Vein Thrombosis’ for additional details.

•           Blood loss – this could occur when a broken hip. Attributable to attainable blood loss, you will get fluid replacement via a drip. Typically a introduction is required.

•           Fracture nonunion – this is often wherever the bone fragments of the fracture don’t heal or be part of back along within the traditional method.

•           Avascular gangrene – this is often a lot of seemingly if you have got an intracapsular hip fracture. The blood offer to the top of the thighbone (the thigh bone) is broken by the fracture. While not blood, the bone tissue will die. this could result in issues as well as chronic pain round the hip.

•           Pressure ulcerations – a pressure ulcer is an cankerous space of skin caused by irritation and continuous pressure on a part of your body. If you are not very mobile and are disbursal long periods in bed or during a chair (as you’re when a hip fracture), you’re at raised risk of developing a pressure ulceration.

What is the prognosis (outlook) when a hip fracture?

This can rely to some extent on however fit your needs were before you stony-broke your hip. However, even for the fittest of individuals, a hip fracture will mean that you simply don’t regain your full quality later on. Some folks might also have persistent pain in their hip space when a fracture. If you were less work after you stony-broke your hip, you will realize that when a hip fracture, it becomes troublesome for you to measure severally.

Some individuals would like additional care after they retreat home when a hip fracture. Others may have to move into a residential or home so they’ll get the additional care with quality that they need.

Can a hip fracture be prevented?

A fall in somebody who has osteoporosis could be a frequent explanation for a hip fracture. Therefore, bar of a hip fracture ought to be geared toward making an attempt to forestall osteoporosis, at treating any osteoporosis that’s already present, and at making an attempt to forestall falls.

The separate leaflet on osteoporosis discusses its bar well. However shortly, osteoporosis prevention includes:

•           Regular weight-bearing exercise like brisk walking, aerobics, dancing, running, etc.

•           Ensuring adequate calcium and cholecarciferol intake in your diet (and attainable supplements for people who is also deficient).

•           Smoking and alcohol – chemicals from tobacco in your blood will have an effect on your bones and create bone loss worse. If you smoke, you must make each effort to stop. Also, hamper on alcohol if you drink heavily.

There are varieties of the way to scale back the possibilities of getting a fall. They include:

•           Looking at any explicit hazards that you simply might have in your home, like loose rugs or furnishings.

•           Having a daily check of your vision.

•           Seeing your doctor frequently for a review of your medication, your vital sign and your general health.

If you’re involved that you simply are in danger of falling, you must discuss this along with your doctor or caseworker.

A note concerning hip protectors

Another factor that has been prompt within the past to do to scale back the prospect of breaking a hip is to wear special artefact around your hip (known as a hip protector) to safeguard your hip if you fall. On the idea of early reports of some trials, hip protectors were prompt as a good plan.

However, there’s increasing proof that hip protectors aren’t effective in preventing a broken hip if you reside at home. Their effectiveness for somebody living in, as an example, a nursing home, is unsure.

Hip fracture

Introduction

The hip joints

Your hip joints attach your thigh bones (femurs) to your pelvis.

Your hip joints are ball-and-socket joints:

•           The ball is the rounded top a part of the thighbone

•           The socket is the concave part of the girdle bone that the rounded end of the thighbone sits within

A hip fracture could be a fracture (crack or break) within the prime end or ‘neck’ of the thighbone, nearest the enarthrosis. The fracture will either be:

•           intracapsular (in the part of the thighbone within the socket of the hip joint)

•           extracapsular (in the part of the thighbone outside the socket of the hip joint)

Hip fractures are cracks or breaks within the top of the thigh bone (femur) near the enarthrosis.

It is generally observed by doctors as a proximal limb fracture.

Symptoms of a hip fracture include:

•           not having the ability to elevate, move or rotate (turn) your leg

•           being unable to face or place weight on your leg, though in some cases this is often attainable

•           a shorter leg, or your leg turning outward additional on the slashed side

If you’re thinking that you’ve got broken your hip, you ought to get to hospital as shortly as possible. This is often probably to mean calling 999 for an ambulance. Strive to not move while you’re awaiting an ambulance and keep warm.

Hip fractures are commonly the results of a fall. A fall will cause a hip fracture if the bones are weak as a result of osteoporosis. Around three million individuals within the UK have osteoporosis.

How common are hip fractures?

Hip fractures are a lot of common in older individuals, largely occurring in those that are around eighty years aged. They’re more a lot of common in ladies.

It is calculable that by the year 2016, there’ll be around 117,000 hip fractures a year within the UK.