Trauma and orthopaedics

Base of Thumb Fractures: A Review of Anatomy, Classification, and Management (2025)

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ype of publication:

Journal article

Author(s):

Younis, Zubair; Hamid, Muhammad A; Devasia, Thomas; *Khan, Muhammad Murtaza; *Abdullah, Faliq; *Singh, Rohit; Simons, Adrian William.

Citation:

Cureus. 17(1):e76729, 2025 Jan.

Abstract:

Fractures of the thumb metacarpal base are uncommon but significant due to their critical role in hand functionality and hand grip strength. These fractures exhibit diverse patterns, including extra-articular, Bennett, Rolando, and highly comminuted fractures, each with unique implications for management and outcomes. Each type presents unique challenges in achieving anatomical reduction, stability, and favorable long-term outcomes. This review explores the anatomy of the trapeziometacarpal joint, classification systems, clinical presentation, imaging techniques, and management strategies for these fractures. Stable extra-articular fractures often respond well to closed reduction and casting, while displaced intra-articular fractures generally require surgical intervention. Bennett fractures are typically treated using closed reduction and percutaneous pinning or open reduction and internal fixation. Rolando and comminuted fractures pose greater challenges due to their inherent instability and often necessitate advanced techniques such as locking plates, external fixation, or arthroscopic-assisted procedures. Achieving anatomical reduction is paramount to prevent complications such as joint incongruity, instability, and post-traumatic arthritis. Optimal treatment approaches depend on fracture patterns, stability, and patient-specific factors, with surgical techniques tailored to preserve thumb function and minimize long-term morbidity.

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Bilateral corneal endothelial decompensation following airbag-induced trauma (2025)

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Type of publication:

Journal article

Author(s):

*Khaliq, Tayyib; *Pummiram, Srivarshini; *Iqbal, Naeem; *Jenyon, Tom.

Citation:

BMJ Case Reports. 18(1), 2025 Jan 27.

Abstract:

Approximately 3% of individuals in road traffic accidents suffer ocular injuries. We present a case of a man in his late 80s who presented with bilateral corneal decompensation following airbag deployment during a road traffic accident. Ocular examination revealed multilevel ocular injury with severe bilateral corneal oedema. This was managed with topical steroids, mydriatics and antibiotic therapy. At 1-month follow-up, the left eye had persistent corneal oedema. Specular microscopy was performed which confirmed endothelial cell loss making the patient a candidate for a corneal endothelial graft. We observed blunt trauma from airbag deployment causing endothelial cell loss and subsequent corneal decompensation. Our findings suggest that patients presenting to the emergency department with facial trauma from airbag injury should be referred for comprehensive ophthalmological assessment and that the reviewing ophthalmologist should have endothelial cell loss in mind during examination.

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Early Screening for Confusion and Vitamin D Deficiency in Elderly Hip Fracture Patients: A Quality Improvement Initiative to Mitigate the Risk of Postoperative Delirium (2024)

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Type of publication:

Journal article

Author(s):

Younis, Zubair; *Gurukiran, Gurukiran; *Abdullah, Faliq; *Kumar, Sairam; Ford, David; Hamid, Muhammad A; Wani, Kubra Farooq.

Citation:

Cureus. 16(12):e75099, 2024 Dec.

Abstract:

Background Postoperative delirium (POD) is a common and debilitating complication in elderly hip fracture patients, associated with significant clinical and functional consequences. Early identification of risk factors, such as cognitive impairment and vitamin D deficiency, is essential to mitigate its impact. However, preoperative screening practices are often inconsistent. This quality improvement initiative aimed to assess and improve compliance with early confusion and vitamin D screening in elderly hip fracture patients, with the goal of facilitating timely interventions to reduce the risk of POD. Methods A two-cycle audit was conducted in the Trauma and Orthopaedics Department at Royal Shrewsbury Hospital. The first cycle (April-June 2023) assessed baseline compliance with confusion (Abbreviated Mental Test Score (AMTS)) and vitamin D screening within 24 hours of admission. Identified barriers informed an intervention consisting of educational sessions, visual prompts, and checklist integration. The second cycle (August-October 2023) evaluated the impact of these measures. Compliance rates, timing of
assessments, and prevalence of abnormal biochemical and cognitive screening results were analyzed using Fisher's exact test (p < 0.05). Results Baseline compliance with screening was 27 patients (27%) out of 100, with primary barriers including lack of awareness and logistical challenges. Post-intervention compliance improved significantly for 54 patients (52.4%) out of 103 (p = 0.0003). Screening timeliness also increased, with 45 patients (83.33%) out of 54 screenings completed within 24 hours in cycle 2 compared to 14 patients (51.85%) out of 27 in cycle 1 (p = 0.0039). Biochemical analysis revealed persistently high rates of vitamin D deficiency, underscoring the need for early detection. AMTS scores correlated with abnormal confusion screens but highlighted limitations in cognitive-only assessments. Conclusion This quality improvement (QI) initiative demonstrated the efficacy of targeted interventions in improving screening compliance for confusion and vitamin D deficiency in elderly hip fracture patients. The findings advocate for integrating proactive, dual-focused screening protocols into clinical workflows to address modifiable risk factors for POD. Future research should explore the long-term impact of such measures on POD incidence, recovery trajectories, and functional outcomes while emphasizing the need
for sustained adherence to screening protocols.

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Lisfranc Injury: a Comprehensive Analysis of Long Term Outcomes - the Oswestry Experience. (2024)

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Journal article

Author(s):

*Patel, R; Cheruvu, M S; Daoub, A; *Singh, R A; Banerjee, R; Hill, S.

Citation:

Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 91(6):369-375, 2024.

Abstract:

PURPOSE OF THE STUDY: Lisfranc is a challenging injury both diagnostically and surgically, with sparse long-term literature evidence of surgical practice. We aim to review our long-term specialist orthopaedic institutional experience of Lisfranc injuries and the surgical management of this complex injury, specifically considering surgical outcomes as per radiological and clinical assessment.

MATERIAL AND METHODS: We present data from a prospectively maintained institutional database, reviewing patients who underwent operative fixation for Lisfranc injury between April 2014 and August 2020. Patients were referred to our institution from hospitals across the country. We included all operatively managed Lisfranc injuries, primary procedures, and patients over the age of 16. Revision procedures, open injuries, polytrauma patients, patients under the age of 16, and those with multiple
foot injuries were excluded. We assessed post-operative results as per the Wilpulla radiographic and clinical criteria.

RESULTS: We treated 27 patients across the study period, of mean age 37.5 (SD 18.3), 55% male and 45% female. 33.3% of our patients were obese as defined by body mass index >30. As per the Myerson classification, we had 2 category A, 24 category B, and 1 category C injuries. Time to operation was median 14 days (range 0-116), with 2 delayed presentations following failure of conservative treatment. Our median length of stay was 1 day (range 0-16). We had 3 complications: 2 wound infections and 1 re-operation for non-union. Post-operative assessment as per Wilpulla demonstrated 74% of good, 18.5% fair and 7% poor fixation results.

CONCLUSIONS: In our institutional experience, partial congruity lateral displacement injuries were the majority of surgical referrals. Surgical treatment through open reduction and internal fixation delivers good clinical and radiographically anatomical results. Further to conventional mechanisms of injury, we propose obesity to be an important risk factor for indirect, low-energy injuries that may help identify this injury.

Functional Outcomes in the Distal End of Radius Fracture: A Prospective Study in a Tertiary Care Center (2024)

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Type of publication:

Journal article

Author(s):

*Thusoo, Varun; Chakrapani, Arjun S; Nehru, Ashish; Kudyar, Sachin; Nagpal, Brahmpreet; Kv, Alok; S, Ebin; Jose, Akhil.

Citation:

Cureus. 16(11):e74226, 2024 Nov.

Abstract:

OBJECTIVES: The objectives of this study are to determine the functional outcomes and compare them between conservative and surgical management in patients managed for closed-type intra-articular distal end of radius fractures.

METHODS: A prospective observational study was done on 150 patients who underwent treatment for closed-type intra-articular distal end of radius fractures. As per Frykman Classification, they were type III. patients were either managed conservatively, i.e. 100 patients out of 150 and surgical management was done in 50 cases. For surgical management, implants used were K-wires, Schanz pins, and Ellis Plate. The functional outcomes were noted in terms of pain and range of motion, in the follow up of six months. Union was noted clinically and radiologically.

RESULTS: The mean age of the study patients was 42.32 +/- 15.77 years. Out of 150 patients, there were 100 (66.67%) male patients. Compared to conservative management, surgical management had significantly lesser time of union (12 vs. 20 weeks, P<0.0001); significantly more excellent results (44% vs. 30%), more good results (32% vs. 15%) (P=0.003); comparable pain score (P=0.236); and comparable functional score (P=0.661). Regarding radiological outcomes, surgical management had significantly more volar tilt (9.6+/-2.5degree vs. 8+/-5degree, P=0.035); lesser Ulnar variance (3+/-2 vs. 4+/-2 mm, P=0.004), lesser grip strength <50% (26% vs. 65%, P<0.0001); comparable radial inclination (21+/-4degree vs. 20+/-5degree, P=0.661); and comparable radial height (11+/-3 vs. 10+/-5 mm, P=0.195)

CONCLUSION: To conclude, surgery for distal radius fractures promotes faster healing, lesser pain, lesser malunion, and better functional outcomes. However, it is not without potential risks. Non-surgical treatment is still a suitable option, for patients with contraindications to surgery or having lower need for functional improvement.

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Functional Outcomes and Complications After Open Reduction and Internal Fixation of Mid-shaft Clavicle Fractures: A Retrospective Study (2024)

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Type of publication:

Journal article

Author(s):

Hamid, Muhammad A; *Younis, Zubair; Mannan, Muhammad; Shrivastava, Nayan; Prabhu, Rudra M.

Citation:

Cureus. 16(11):e74302, 2024 Nov.

Abstract:

INTRODUCTION: Clavicle fractures are routinely encountered in orthopedic clinical practice and have often been the subject of debate when it comes to optimal treatment. Clavicle fracture surgery has come a long way with excellent pre-contoured superior locking plates available for fixation. This study aimed to evaluate a cohort of patients operated for displaced mid-shaft clavicle fractures by open reduction and internal fixation using superior clavicle locking plates.

MATERIALS AND METHODS: This is a retrospective cohort study of mid-shaft clavicle fracture patients who were operated on and had their fractures fixed using superior clavicle locking plates. We identified a total of 29 patients to be included in this study. The primary outcome measure was the quickDASH score at the time of discharge (12 weeks from surgery). Secondary outcome measures were the pattern and frequency of complications, and the need for metalwork removal.

RESULTS: Our study had a male preponderance, with 19 (65.5%) patients being male. The most common mode of trauma was fracture secondary to a road traffic accident in 12 (41.4%) patients. All but one fracture united uneventfully. The mean quickDASH score was 0.94 at 12-week follow-up. Complications were noted in 12 (41.4%) patients, and the most common complication was hardware irritation in seven (24.1%) patients, followed by dysesthesia around the surgical scar in five (17.2%) patients.

CONCLUSION: Open reduction and internal fixation of the clavicle give a high likelihood of fracture union along with good shoulder function. In a particular cohort of patients, this offers a quick recovery and earlier return to activity. However, this must be balanced with the risk of complications in a considerable proportion of operated patients, some of which might necessitate a second surgery.

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Evaluation of Patient-Initiated Follow-Up (PIFU) Service in a Fracture Clinic: A Comprehensive Service Evaluation and Patient Satisfaction Audit (2024)

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Type of publication:

Journal article

Author(s):

*Younis, Zubair; Hamid, Muhammad A; *Khan, Muhammad Murtaza; Sapra, Rahul; *Gurukiran, Gurukiran; *Singh, Rohit.

Citation:

Cureus. 16(11):e73461, 2024 Nov.

Abstract:

Background Outpatient clinics are increasingly challenged by high patient volumes and rising "did not attend" (DNA) rates, leading to extended wait times and declines in patient satisfaction. Traditional follow-up (FU) models with routinely scheduled appointments contribute to inefficiencies, as stable patients may attend unnecessary visits, thus straining clinic resources. The patient-initiated follow-up (PIFU) model offers an alternative where patients schedule appointments only when necessary. This study evaluates PIFU's efficacy in improving outpatient services and patient satisfaction by reducing routine appointments and prioritizing patient-driven follow-up. Methods This service evaluation and patient satisfaction audit was conducted at the fracture clinic of Royal Shrewsbury Hospital over three months (December 2023-March 2024). Out of 3828 patients seen, 203 were assigned to PIFU based on criteria indicating stable conditions with minimal follow-up requirements. The remaining patients were either scheduled for routine follow-ups or discharged. Data were collected retrospectively from clinic records, and a structured
questionnaire assessed patient satisfaction with the PIFU service. Results Among the 203 patients assigned to PIFU, 183 (90.15%) patients received an informational leaflet, with all respondents finding it easy to understand. However, only 41 (20.2%) of patients utilized the PIFU service, primarily for concerns about pain, healing, or complications. Satisfaction among PIFU users was high, with 163 (80.3%) patients rating the service 5/5. Non-users mostly cited no perceived need for follow-up. Demographic analysis indicated that patients aged 40-60 were predominant (n=132; 65.02%) among the PIFU cohort. Conclusion The PIFU model demonstrated the potential to alleviate clinic workload by reducing routine follow-ups while maintaining high patient satisfaction. Although utilization rates were low, those who engaged found the service beneficial, suggesting PIFU's value for patients comfortable with self-management. Improved patient education may enhance engagement, supporting the broader implementation of PIFU in outpatient settings. Further research is warranted to explore barriers to patient-initiated follow-up and refine eligibility criteria for optimal outcomes.

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Proximal Humerus Fractures: A Review of Anatomy, Classification, Management Strategies, and Complications (2024)

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Type of publication:

Journal article

Author(s):

Younis, Zubair; Hamid, Muhammad A; Amin, Jebran; *Khan, Muhammad Murtaza; *Gurukiran, Gurukiran; Sapra, Rahul; *Singh, Rohit; Wani, Kubra Farooq; Younus, Zuhaib.

Citation:

Cureus. 16(11):e73075, 2024 Nov.

Abstract:

Proximal humerus fractures are prevalent in older adults, particularly women, primarily due to osteoporosis and increased fall risk. These fractures often result from low-energy falls in elderly patients, while in younger individuals, they are more likely to occur with high-energy trauma, which may involve additional injuries to soft tissue and neurovascular structures. Proper anatomical understanding, including key structures and blood supply, is crucial for effective management and to prevent complications. Several classification systems assist in guiding treatment for proximal humerus fractures, including Codman's, Neer's, Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) system, and the Codman-Hertel system, which helps predict ischemia risk. Evaluation of proximal humerus fractures begins with Advanced Trauma Life Support (ATLS) protocols, emphasizing a thorough shoulder assessment, particularly focusing on skin integrity in elderly patients. Neurological and vascular examinations are essential due to the common occurrence of nerve injuries, especially involving the axillary nerve. Imaging typically includes multiple standard views, with advanced imaging reserved for complex cases and for assessing associated soft tissue injuries. Treatment options range from conservative management for stable fractures to surgical intervention for more complex cases. Surgical choices include techniques like fixation, nailing, and various arthroplasty options, with some procedures potentially offering advantages for older adults with bone quality or soft tissue challenges. Rehabilitation is a vital component of recovery, with emphasis on early mobility and gradual strengthening to restore function, especially in older patients. Complications following open reduction and internal fixation (ORIF) for proximal humerus fractures can include issues such as non-union, malunion, osteonecrosis, infection, joint stiffness, and fixation failure. In cases where non-union or fixation failure occurs, revision surgery or arthroplasty may be necessary. Joint stiffness may require further intervention if physical therapy is insufficient, while symptomatic osteonecrosis might also need surgical management. Malunion is generally better tolerated in older patients but may require correction in younger individuals. Other surgical options, such as hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA), share similar risks, including infection, fractures, complications at the tuberosity, stiffness, and instability. RSA may be favored when there are tuberosity or rotator cuff issues. Closed reduction with percutaneous pinning carries a high risk of pin migration and malunion, which can result in deformities, pain, and dysfunction. Proper anatomical knowledge is essential to avoid neurovascular injury and to manage common issues such as pin-site infections effectively.

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The National Joint Registry Data Quality Audit of elbow arthroplasty (2024)

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Type of publication:

Journal article

Author(s):

Hamoodi, Zaid; Shapiro, Joanne; Sayers, Adrian; Whitehouse, Michael R; Watts, Adam C; Abbott, Jennifer; Abbott, Sarah; Adebayo, Oliver; Ahmad, Kashif; Ahrens, Philip; Akinfala, Michael; Al-Hadithy, Nawfal; Al-Najjar, Majed; Amirfeyz, Rouin; Ankarath, Sudhi; Ashton, Fiona; Aulton, Kelly; Auplish, Sunil; Austin, Jane; Ayeko, Segun; Azhar, Raja; *Bahia, Rish; Baines, Steven; Baldomir, Marisol; Barai, Sneha; Barkham, Benjamin; Barrett, Emily; Batten, Timothy; Bavan, Luckshman; Baxter, Jonathan; Beaumont, Sera; Bentley, James; Bhabra, Gev; Bhat, Mahendar; Bhatt, Ankit; Bhingraj, Mahmoud; Bhutta, Aqeel; Bingham, Samuel; Blastland, Jenny; Boardman, David; Boateng, Michael; Bojarska, Kasia; Boksh, Khalis; Booker, Simon; Borreshi, Sebastian; Bould, Michael; Boulton, Lesley; Brannan, Linda; Breidaka, Zarina; Brereton, Rachel; Brinsden, Mark; Brooker, Joanne; Brookes, Sabine; Broux, Cheryl; Brown, Elke; Browne, Jacqueline; Bryant, Richard; Buchanan, James; Buck, Lisa; Burnett, Karen; Burrows, Melanie; Burt, Jill; Burton, David; Butt, Usman; Campaner, Barry; Candal-Couto, Jaime; Carvell, Hannah; Chakravarthy, Jagannath; Chatterji, Somashree; Chaudhury, Salma; Chauhan, Govind S; Chojnowski, Adrian; Cittambalam, Janani; Clark, David; Gosia Clarke, Malgorzata; Clarke, Ben; Clelland, Andrew; Cochrane, Roz; Colbridge, Karen; Cook, Hayley; Cooper, Becky; Correa, Elizabeth; Craven, Joanna; Crawford, Jason; Curtis, Sherri; Cuthbert, Rory; Dainton, Jeremy; Dale, Lisa; Davies, Sammy; Davis, Joanne; Davis, Vicky; Dean, Ben; Dehler, Tom; Dennis, Sonu; Der Tavitian, Jacob; Desai, Aravind; Dhillon, Sukhraj S; Dias, Richard; Dickinson, Graham; Dirckx, Margo; Dixon, Oliver; Docker, Charles; *Dodenhoff, Ronald; Domos, Peter; Draviaraj, Kingsleypaul; Drew, Steven; Duff, Caroline; Duffin, Sarah; Durham, Paula; Earnshaw, Kirstie; Edakalathur, Jefin; Edwards, Michelle; Elahi, Zain; Else, Samantha; Emara, Moustafa; Eng, Khemerin; Esfandiari, Alireza; Esler, Colin; Evans, Jon; Everall, Alicia; Eyre-Brook, Alistair; Farhan-Alanie, Muhamed; Federer, Simon; Ferdinandus, Sharon; Finch, Marie; Fischer, Jochen; Flood, Catherine; Forde, Christine; Forder, Justin; Fowler, Lisa; Franklin, Marieta; Gacaferi, Hamez; Gamble, David; Garg, Sunil; *Gill, Vicki; Ginley, Jean; Glancey, Emma; Glanville, Gemma; Gmati, Aimen; Goddard, Karen; Goel, Jay; Goldsmith, Carly; Gooding, Ben; Goodwin, Fiona; Goring, Benjamin; Goude, Will; Guyver, Paul; Haines, Samuel; Haque, Aziz; Hardley, Thomas; Haritonow, Susan; Harnett, Louise; Harris, Joanna; Harris, Margaret; Harrison, Jane; Hauffe, Isabelle; Hawken, Archie; Hawkes, Dave; Hay, Stuart; Haywood, Mia; Hedge, Siddhant; Hickey, Susan; Hickinson, Anne; Higgs, Deborah; Hill, Richard; Hill, Sharyn; Hind, Jamie; Hitchcock, Maria; Holdcroft, Terry; Holdcroft, Emily; Holliday, Ann; Hudson, Siobhan; *Hughes, Hazel; Imtiaz, Rabia; Iqbal, Sheeraz; Jabr, Yamen; Jackson, Crystal; Jameson, Jackie; Jayme, Odette; Jennings, Andrew; Jenvey, Cara; Jewitt, Elizabeth; Jimenez, Andreea; Joby, John; Jones, Adrian; Jones, Neil; Jovanovic, Jadranka; Kabala, Vanessa; Kang, Niel; Kausor, Gulnaz; Kaynes, Sarah; Keane, Conal; Keen, Lauren; Kelly, Gaynor; Kent, Matthew; Kent, Jonathan; Kerr, Carla; Kerr, Julie; King, Christina; Kinnair, Anthony; Kinsley, Gemma; Konarski, Alastair; Kord, Jacqueline; Kumar, Hari; Kumar, Sachin; Lafferty, Rebecca; Lancaster, Patrick; Levitt, William; Lewin, Alexandria; Li, Yueyang; Liew, Ignatius; Yizhe Lim, Martin; Lipscombe, Stephen; Lynch, Edith; MacInnes, Scott; Madden, Paula; Maddocks, Nick; Mahajan, Ravindra; Mahoney, Rachel; Malik, Sheraz; Mannan, Syed; Maris, Alexandros; Markey, Michael; Martin, Christy; Martin, Rebecca; Masunda, Stanley; Mazis, George; Mcauliffe, Anne-Marie; McBride, Tim; McGowan, Amy; Mckeown, Nicolee; McLauchlan, George; McNally, Debbie; Melton, Joel; Miller, Jane; Millyard, Cathy; Mitchell, Claire; Mohamed, Foad; Mohamed, Abdalla; Charlotte Montgomery, Helen; Munn, Darren; Mutimer, John; Nanda, Rajesh; Neen, Daniel; Newton, Lynne; Newton, Ashley; Nicholl, Aly; Nightingale, Jessica; Ogden, Emma; Orton, Peter; Oswald, Lynda; Page, Kelly; Paius, Maria; Papanna, Madhavan; Patel, Neelam; Paul, Claudia; Peach, Chris; Pegg, Derek; Penfold, Sue; Phillips, Eleanore; Pickering, Greg; Plakogiannis, Christos; Platt, Julie; Pole, Craig; Potter, Richard; Povall, Kate; Pradhan, Riten; Prasad, Ganesh; Price, Karen; Pride, Julie; Prins, Afnan; Qazzaz, Layth; Radhakrishnan, Ajay; Ramesh, Ashwanth; Rashid, Adil; Rashid, Abbas; Rasidovic, Damir; Ratford, Emily; Rayner, Jan; *Rhee, Jae; Rice-Evans, Matthew; Ricketts, Martha; Roach, Deborah; Waters, Eve R; Robinson, Simon; Robinson, Paul; Rodgers, Samantha; Rogers, Emma; Rooney, Aaron; Rossouw, Dan; Roy, Bibhas; Sadiqi, Maseh; Sagmeister, Markus; Samy, David; Sanders, Paige; Sanderson, Kelly; Sandher, Dilraj; Sargazi, Nastaran; Saunders, Mark; Saunders, Nicky; Savage, Kim; Sawalha, Seif; Schouw, Melissa; Scott,   Gareth; Selzer, Gunther; Sepesiova, Lucia; Shah, Sohan; Shahane, Shantanu;   Shaw, Grant; Shrestha, Suzani; Shutt, John; Siddiqui, Nashat; Sidharthan, Sijin; Simons, Adrian; Simpson, Vera; Sinclair, Pierre; Siney, Paul; Singh, Jagwant; Singh, Bijayendra; Singh, Harvinder; Sinha, Apurv; Smith, Callum; Smith, Christopher; Smith, Kerry; Somanchi, Brinda; Soufan, Muhab; Southgate, Cynthia; Southgate, Jeremy; Spearpoint, Nicola; Stainer, Rebecca; Stevens, Richard; Stimler, Batya; Stone, Andrew; Suter, Danielle; Talbot, Charlie; Tareef, Tareq; Theivendran, Kanthan; Thomas, Beverely; Thomas, William; Thompson, Andrew; Thompson, Jackie; Thornhill, Elizabeth; Titchener, Andrew; Townley, Michael; Tozer, Tina; Truman, Jennie; Truss, Adam; *Turner, Rob; Van Rensburg, Lee; Venugopal, Vinayak; Vollans, Sam; Waller, Louise; Walsh, Anna; Waraich, Aleena; Wei, Nicholas; James White, William; Wilkinson, Mark; Williams, Daniel; Williams, Philip; Williams, Nicola; Wilson, Stephanie; Wood, David; Yadu, Shirley; Yarashi, Tejas; Zeolla, Julian; Zreik, Nasri H; Ollivere, Ben.

Citation:

Bone & Joint Journal. 106-B(12):1461-1468, 2024 Dec 01.

Abstract:

Aims: The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow.

Methods: It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and
correct them.

Results: Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties.

Conclusion: The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a
trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research.

Labelling of Fluids in the Sterile Field During Orthopaedic Surgery: A Quality Improvement Initiative (2024)

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Type of publication:

Journal article

Author(s):

Sweetman, Benedict; *Younis, Zubair; Khan, Sarfraz; Amin, Jebran; Mohammed, Ghulam Dastagir Faisal; Jones, Ellen Ellysia; Lemaigre, Charlotte; Pydah, Satya.

Citation:

Cureus. 16(10):e72250, 2024 Oct.

Abstract:

Background Intraoperative safety protocols, including proper labelling of syringes, are critical to patient safety in surgical settings. While the Royal Pharmaceutical Society and the Royal College of Anaesthetists provide clear guidelines to prevent medication errors, ensuring consistent compliance with labelling protocols in the fast-paced and complex environment of orthopaedic surgery can still present practical challenges. The absence of proper labelling, combined with the use of multiple fluids such as normal saline, disinfectants, and local anaesthetics, increases the risk of adverse outcomes due to fluid misidentification. This quality improvement project aimed to assess current labelling practices in a district general hospital, identify barriers to compliance, and develop a cost-effective solution. Methodology The project was conducted in three orthopaedic theatres over two audit cycles. During the first audit cycle, 30 procedures were observed to assess compliance with labelling guidelines. Compliance was defined as the labelling of all syringes containing fluids present in the sterile field. Following this, an intervention was introduced, using surgical marker pens and sterile stickers for fluid labelling, along with a mandatory "tactical pause and check" and an awareness campaign. Two months later, a second audit of 34 procedures was conducted to evaluate the effectiveness of the intervention. Results In the first audit cycle, only three out of 30 procedures (10%) were compliant with labelling guidelines. Following the intervention, compliance increased dramatically to 32 out of 34 procedures (94%). The results were statistically significant (p < 0.05) as determined by Fisher's exact test. The use of sterile stickers and marker pens proved to be a simple and cost-effective solution that did not interfere with the sterile environment or increase costs. Conclusions This study demonstrates that a low-cost intervention using sterile stickers and surgical marker pens can significantly improve compliance with fluid labelling guidelines in orthopaedic surgery, thereby enhancing patient safety. While the intervention was successful, future research should explore more sustainable solutions, such as pre-printed sterile labels, and evaluate the long-term impact of such interventions across various surgical settings. Continuous education and regular audits will be essential in maintaining high compliance rates.

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