Trauma and orthopaedics

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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An overview of cell salvage in orthopaedic hip and knee arthroplasty surgery (2024)

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Type of publication:

Journal article

Author(s):

*Patel, Ravi; Golding, Steven; Nandra, Rajpal; Banerjee, Robin.

Citation:

Journal of Perioperative Practice. 2024 Nov 12.[epub ahead of print]

Abstract:

Blood management is a critical aspect of patient care during surgical procedures. In the United Kingdom, there is a growing recognition of the need to integrate intraoperative cell salvage into blood management protocols, especially for invasive surgeries where significant blood loss is anticipated. While donated blood (allogeneic blood) is traditionally used in such cases, it carries risks and potential complications. Consequently, intraoperative cell salvage presents itself as an appealing alternative, particularly in hip and knee arthroplasty procedures. Intraoperative cell salvage involves the collection and reinfusion of a patient's own blood (autologous blood) lost during surgery. Studies have consistently shown that autologous blood collected via intraoperative cell salvage has fewer complications and greater benefits compared to donated blood. However, despite these advantages, the widespread adoption of intraoperative cell salvage in UK hospitals remains limited, primarily due to associated costs. While the integration of intraoperative cell salvage into blood management services may incur initial expenses, research suggests that it could ultimately prove to be cost-effective. This is because improved patient outcomes associated with intraoperative cell salvage may lead to reduced postoperative complications and shorter hospital stays. Thus, there is a growing imperative to overcome financial barriers and promote the implementation of intraopertive cell salvage as a standard practice in perioperative care across UK health care settings. The purpose of this scoping literature review is to consolidate the available information on the current use of intraoperative cell salvage and to identify intraoperative cell salvage techniques and devices described for use in an arthroplasty setting.

Fear of reinjury after acute Achilles tendon rupture is related to poorer recovery and lower physical activity postinjury (2024)

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Type of publication:

Journal article

Author(s):

Larsson, Elin; LeGreves, Agnes; Brorsson, Annelie; Eliasson, Pernilla; Johansson, Christer; *Carmont, Michael R; Nilsson Helander, Katarina.

Citation:

Journal of Experimental Orthopaedics. 11(4):e70077, 2024 Oct.

Abstract:

Purpose: The aim of this study was to investigate how fear of reinjury to the Achilles tendon affects return to previous levels of physical activity and self-reported Achilles tendon Total Rupture Score (ATRS) outcomes.

Methods: Data were collected from a large cohort of patients treated for an acute Achilles tendon rupture at Sahlgrenska University Hospital Molndal between 2015 and 2020. The ATRS and additional questions concerning fear of reinjury, treatment modality, satisfaction of treatment and recovery were analyzed 1-6 years postinjury. Analysis was performed to determine the impact of fear of reinjury on patient-reported recovery and physical activity.

Results: Of a total of 856 eligible patients, 550 (64%) answered the self-reported questionnaire and participated in the follow-up. Of the participants, 425 (77%) were men and 125 (23%) were women. ATRS, recovery in percentage, satisfaction of treatment, recovery on a 5-point scale and physical activity level post- versus preinjury were significantly related to fear of reinjury (p < 0.001). Of the nonsurgically treated patients, 59% reported fear of reinjury compared to 48% of the surgically treated patients (p = 0.024) Patients that reported fear of reinjury had a 15-point lower median ATRS score than those who did not (p < 0.001).

Conclusion: More than half of patients who have suffered an Achilles tendon rupture are afraid of reinjuring their tendon. Patients who reported fear of reinjury exhibited a significantly lower ATRS score. This indicates the importance of addressing psychological aspects in the treatment after this injury.

Level of Evidence: Level II.

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Percivall Pott (1713-1788): Father of Orthopaedics and Pioneer of Occupational Medicine (2024)

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Type of publication:

Journal article

Author(s):

*Forster, Seth.

Citation:

Cureus. 16(10):e70608, 2024 Oct.

Abstract:

Percivall Pott was an eighteenth-century English surgeon best known for three eponymous diseases: Pott's fracture, Pott's puffy tumour and Pott's disease of the spine. He wrote extensively, with treatises covering a wide range of surgical subjects, including cataracts, cranial trauma, hernias
and neurology. Pott's practice came at a time when surgery was being transformed from the work of barbers into a scientific study. His publications had a wide-reaching impact, influencing contemporary practice and setting out building blocks for the work of those who came after him. This article aims to explore the life and career of Percivall Pott, looking in particular at his influence on the subjects of orthopaedics and occupational medicine.

UK Foot and Ankle Thromboembolism (UK-FATE) (2024)

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Type of publication:

Journal article

Author(s):

Mangwani, Jitendra; Houchen-Wolloff, Linzy; Malhotra, Karan; Booth, Sarah; Smith, Aiden; Teece, Lucy; Mason, Lyndon W; Shaikh, Rabia; Alfred, Wilam; Okhifun, Imobhio; Cinar, Ece; Bua, Nelson; Vemulapalli, Krishna; Acharya, Ashok; Gadd, Richard; Money-Taylor, John; Kantharaju, Rohit; Bhosale, Abhijit; Bahri, Suchita; Broadbent, Rosie; Drummond, Isabella; Jones, Neil; Shah, Savan; Ravindrarjah, Thuwarahan; Yasen, Zaid; Singh, Kunjshri; Al-Habs, Ruqaiya; Jeyaseelan, Lucky; Habbiba, Abdullah; Walker, Thomas; Dewhurst, Maximilian; Glasgow, Nisha; Eze, Dominic; Carter, Gary; Rajan, Praveen; Patil, Vijay; Amer, Omer; Malik, Kalim; Pavanerathan, Pranavan; Mallick, Arijit; Seferiadis, Ilias; Currall, Verity; Sadasivan, Preetha; Kumar, Sunil; Sanjani, Shahrukh R; Ciaccio, Maria; Ayyaswamy, Brijesh; Prasad, Pradeepsyam; Anand, Mr; Sunilraj, Dr; Lane, Suzanne; Prathap, Swetha; Kankate, Raghubir; Aktselis, Ioannis; Davda, Kinner; Vijapur, Arvind; Tayyem, Mohammed; Chau, Jackie; Azhar, Muhammad S; Sturdee, Simon; Hussain, Halima; Sonde, Sarah; Luqman, Muhammad Q; Farooq, Rahy; Wells, Gareth; Shenolikar, Aneil; Simons, Michiel; Hodgson, Paul; Thomas, Rhys; Stevens, Sam; Elhassan, Yahya; Adeniyi, Adebowale; Aspinall, Will; Joseph, Vinay; Day, Miriam; Tong, Aureola; Joyner, Claire; Alzaranky, Muhammed; Elhassan, Osman; Chhantyal, Kishor; Arora, Abhishek; Abiddin, Zain; Kucharski, Robert; Ahmad, Irfan; Zeb, Junaid; Ishaq, Usman; Thomas, Jija; Jain, Kowshik; Deol, Rupinderbir; Faroug, Rad; Johal, Karan; Mordecai, Simon; Argyropouos, Miltiadis; Chawla, Amit; Ibrahim, Mohamed; Pereira, Marta; Barr, Lynne; Julies, Elda; Hill, Francesca; Kapoor, Smriti; Bailey, James; Mukhopadhyay, Ishani; Rana, Sarina; Tarig, Hamza; Qualaghassi, Mahdi; Seewoonarian, Sheena; Rose, Barry; Crate, Georgina; Abbott, Sarah; Fenner, Christopher; Geleit, Ryan; Yousaf, Sohail; Akram, Nimra; Al-Hubeshy, Zahra; Patel, Bhavi; Hussein, Mohamed; Clark, Callum; Giddie, Jasdeep; Dega, Raman; Dasari, Kishore; Nandhara, Gurbinder; Kumar, Pritesh; Gupta, Prateek; Poole, Hope; Zace, Pamela; Alvi, Farhan; Jacob, Jagan; Reddy, Raji; Sateesh, Vaishnav; Gledhill, Andrea; Craven, James; Cichero, Matt; Yates, Ben; Newton, Ayla; Grice, John; Fawcett, Nicholas; Fraig, Hossam; Hamad, Farouk; Marsland, Daniel; Elliot, Robin; Ghani, Yaser; Chandrashekhar, Suresh; Millan, Ravi K; Clark, Andrew; Rahman, Kashed; Sykes, Mark; Little, Zoe; Saleem, Jawaad; Jolly, Lewis; Jain, Aman; Qadri, Ansar; Rymaruk, Sophy; Kulkarni, Avadhut; Garabadi, Mohanrao; Akhtar, Meraj; Hossain, Munier; Yunus, Shamael; Saleem, Maleeha; Fong, Joanna; Islam, Amirul; Nusir, Ben; Chapman, James; Holmes, David; Mamoowala, Neville; Almond, Kieran; Wright, Claire; Caruana, Ethan; Watson, Thomas; Allison, Georgia; Pillai, Anand; Madhi, Imad; Alsalihy, Mazin; Elamin, Khadija; Yip, Chee Rong; Tew, Lucy; Dahiya, Rohan; Goff, Thomas; Bagshaw, Oliver; Slade, Henry; Andrzejowski, Paul; Gomati, Ayoub; Drake, Chris; Hind, Jamie; Morgan, Rebecca; Khalaf, Ahmed; Ditta, Adeel; Ramasamy, Arul; McIntyre, Joshua; Blacklock, Calum; Middleton, Scott; Clayton, Robert; Hrycaiczuk, Alex; Thornhill, Christopher; Jeyakumar, Gowsikan; Vaithilingam, Delani; Potter, Kate; Jamal/Pete Chan, Bilal; Mohamed, Muyed; Fraser, Debbie; Elhalawany, Ahmed; Beastall, James; Cousins, Gerard; Nunag, Perrico; Loveday, David; Bawa, Akshdeep; Gilmore, Rebecca; Schankat, Kerstin; Walls, Andrew; Corin, Nicole; Robinson, Peter; Hepple, Steve; Harries, William; Riddick, Andrew; Winson, Ian; Marsh, Luke; Bashir, Muhammad A; Saini, Jigyasa; Atkinson, Henry; Limaye, Rajiv; Johnson-Lynn, Sarah; Sethi, Mohit; Flanagan, George; Uddin, Akram; Reilly, Ian; Martin, Rebecca; Pujol-Nichol, Andrea; Carroll, Natalie; Boucher, Alexander; Alward, Mustafa; Myint, Yuland; Butler, Katherine; Kendal, Adrian; Bugeja, Mark; Mooteeram, Justin; Saedi, Farid; Koc, Togay; Morcos, Zeid; Robertson, Gregory; Holmes, Natal; Tribe, Howard; Pearkes, Tim; Soliman, Ahmed; Prasanna, Anil; Teoh, Kar; Kamat, Sanil; Bajracharya, Abhijit; Reeves, James; Ngwayi, Mbori; Imtiaz, Galal; Blackmore, Noah; Lau, Benjamin; Naik, Arjun; Tung, Eleanor; Murhekar, Siddhartha; Ray, Robbie; Lyle, Shirley; Makwana, Nilesh; Kaisi, Kahlan A; Al-Musabi, Musab; Dean, Mike; Hughes, Adrian; Shuttlewood, Kimberley; Welck, Matthew; Patel, Shelain; Sykes, Adam; Thibbaiah, Mahesh M; Hadi, Hosain; Haldar, Anil; Ardakani, Amir G; Jani, Priyanka; Kutuzov, Vladislav; Gibbons, James; Trussler, Daniel; Hawley, Eve; Akhtar, Sabeen; Rajgor, Harshadkumar D; Budair, Basil; Prem, Hari; Mckenzie, James; Thurston, Daniel; O'Sullivan, Michael; Elmajee, Mohammed; Pond, Erika; *Zahra, Wajiha; *Heaver, Catriona; Igbagiri, Kueni; Gaukroger, Andrew; Solan, Matthew; Peacock, Christian; Fan, Ka S; Barton, Tristan; Robinson, Derek; Graham, Selina; Zeolla, Julian; Everett, Samuel; Iqbal, Mohammad; Gourbault, Lysander; Singh, Shashwat; Tang, Cary; Tarhini, Mariam; Khan, Shahrukh; Balasubramanian, Satishkumar; Lever, Caroline; Bansod, Vaibhav; Iyengar, Kartik; Wadood, Abdul; McMillan, Lara; Toh, Eugene; Masunda, Stanley; Federer, Simon; Ahmad, Faheem; Lashin, Ahmed; Kaddah, Ahmed; Oladeji, Emmanuel; Dawe, Ed; Nolan, Ciaran; El-Bayouk, Khalil; Dhukaram, Vivek; Chapman, Anna; Beddard, Laura; Thomas, Alex; Garg, Vipul; Taylor, Heath; Kelsall, Nikki; Roslee, Charline; Akram, Nimra; Lowdon, Hamish; Kamel-Sherif, Ahmed; Jones, Anette; Best, Alistair; Zabaglo, Mate; Sayani, Junaid; Kyaw, Olive; Khin, Chan; Ali, Ramla; Shaik, Yousufuddin; Hossain, Natasha; Valente, Lucia; Ajis, Adam; Guha, Abhijit; Pereira, Melwyn; Ayoub, Atif; Paraoan, Vlad; Hali, Nayeem; Baird, Charles; Kugan, Raj; Abdallatif, Ahmad; Blomfield, Mark; Jackson, Gillian; Craven, James; Malhotra, Anubhav; Toner, Aileen; Render, Luke; Ashley, Connor; Limb, Richard; Smith, Robert; Hughes, Luke; Matthews, Hannah; Shiers-Gelalis, Fleur; Ting, Jason; Place, Stuart; Budgen, Adam; Stanley, James; Jowett, Charlie.

Citation:

Bone & Joint Journal. 106-B(11):1249-1256, 2024 Nov 01.

Abstract:
Aims: Venous thromboembolism (VTE) is a potential complication of foot and ankle surgery. There is a lack of agreement on contributing risk factors and chemical prophylaxis requirements. The primary outcome of this study was to analyze the 90-day incidence of symptomatic VTE and VTE-related mortality in patients undergoing foot and ankle surgery and Achilles tendon (TA) rupture. Secondary aims were to assess the variation in the provision of chemical prophylaxis and risk factors for VTE. Methods: This was a multicentre, prospective national collaborative audit with data collection over nine months for all patients undergoing foot and ankle surgery in an operating theatre or TA rupture treatment, within participating UK hospitals. The association between VTE and thromboprophylaxis was assessed with a univariable logistic regression model. A multivariable logistic regression model was used to identify key predictors for the risk of VTE. Results: A total of 13,569 patients were included from 68 sites. Overall, 11,363 patients were available for analysis: 44.79% were elective (n = 5,090), 42.16% were trauma excluding TA ruptures (n = 4,791), 3.50% were acute diabetic procedures (n = 398), 2.44% were TA ruptures undergoing surgery (n = 277), and 7.10% were TA ruptures treated nonoperatively (n = 807). In total, 11 chemical anticoagulants were recorded, with the most common agent being low-molecular-weight heparin (n = 6,303; 56.79%). A total of 32.71% received no chemical prophylaxis. There were 99 cases of VTE (incidence 0.87% (95% CI 0.71 to 1.06)). VTE-related mortality was 0.03% (95% CI 0.005 to 0.080). Univariable analysis showed that increased age and American Society of Anesthesiologists (ASA) grade had higher odds of VTE, as did having previous cancer, stroke, or history of VTE. On multivariable analysis, the strongest predictors for VTE were the type of foot and ankle procedure and ASA grade. Conclusion: The 90-day incidence of symptomatic VTE and mortality related to VTE is low in foot and ankle surgery and TA management. There was notable variability in the chemical prophylaxis used. The significant risk factors associated with 90-day symptomatic VTE were TA rupture and high ASA grade.

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Enhancing Junior Doctors' Preparedness and Satisfaction in Trauma and Orthopaedics: A Quality Improvement Project With the Development of a Comprehensive Guidebook (2024)

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Type of publication:

Journal article

Author(s):

Mohammed, Ghulam Dastagir Faisal; *Younis, Zubair; Amin, Jebran; Mansoor, Zaina; Lingnau, Leonie; Jesudason, Edwin P.

Citation:

Cureus. 16(9):e70061, 2024 Sep.

Abstract:

BACKGROUND: Junior doctors often feel underprepared for their trauma and orthopaedics (T&O) rotation due to limited exposure during medical school and inadequate support. This project aimed to enhance junior doctors' preparedness and satisfaction during their T&O rotation by developing a comprehensive guidebook that addresses key orthopaedic knowledge and logistical challenges. METHODS: A quality improvement project (QIP) was conducted at Ysbyty Gwynedd Hospital. Initial surveys identified factors contributing to poor experiences during the trauma and orthopaedics rotation, including limited knowledge of orthopaedic emergencies and a lack of useful reference resources. A guidebook was developed and refined through multiple plan-do-study-act (PDSA) cycles. The guidebook covered topics such as orthopaedic emergencies, common injuries, referral pathways, and hospital logistics, presented in an accessible flowchart format. RESULTS: The primary objective of achieving 75% satisfaction among junior doctors was successfully met, with satisfaction increasing from four (40%) to eight (80%) doctors in the most recent survey. Secondary outcomes included a marked improvement in the understanding of quality improvement projects, rising from three (30%) to eight (80%) doctors. Orthopaedic knowledge also saw a significant enhancement, increasing from four (40%) to nine (90%) doctors. Confidence in handling night on-call duties improved dramatically, with all 10 doctors (100%) reporting increased confidence, compared to four (40%) doctors initially. Additionally, seven doctors (70%) expressed a greater interest in pursuing a career in orthopaedic surgery. CONCLUSION: The comprehensive guidebook significantly improved junior doctors' preparedness and satisfaction during their T&O rotation. While the guidebook is a valuable resource, ongoing mentorship and hands-on experience remain essential for long-term success. Replication of this project across other departments and hospitals is recommended to assess its broader applicability and impact.

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A literature review assessing the perioperative efficacy and safety of tranexamic acid in elective total hip and knee arthroplasty in UK practice (2024)

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Type of publication:

Journal article

Author(s):

*Patel R.; Golding S.; Nandra R.; Banerjee R.;

Citation:

Journal of perioperative practice. (pp 17504589241278478), 2024. Date of Publication: 20 Sep 2024 [epub ahead of print]

Abstract:

Hip and knee arthroplasty are frequently associated with significant blood loss, often necessitating blood transfusions. A variety of methods are employed to minimise blood loss and consequently mitigate the necessity for transfusions. This review explores the incidence of blood loss in hip and knee arthroplasty alongside perioperative strategies aimed at its reduction in UK practice. Given the increasing prevalence of tranexamic acid utilisation, we systematically examine the extant literature concerning its application in patients undergoing hip and knee arthroplasty. Our analysis discerns a prevailing consensus within published studies favouring the implementation of tranexamic acid as a safe and efficacious measure for reducing blood loss during hip and knee arthroplasty procedures.

Lateral femoral wall thickness in trochanteric hip fractures: a systematic review (2024)

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Type of publication:
Systematic Review

Author(s):
*Selim, Amr; Ponugoti, Nikhil; Daoub, Ahmed; Johnson-Lynn, Sarah; *Rhee, Shin Jae.

Citation:
Hip International. 2024 Aug 26.[epub ahead of print]

Abstract:
BACKGROUND: Thin lateral femoral wall has been investigated as a sign of instability in trochanteric hip fractures, necessitating lateral wall reconstruction or the use of a cephalomedullary nail (CMN). Various cut-off values have been proposed to guide implant choice. This review aims to determine the clinical significance of the lateral femoral wall thickness (LWT) in trochanteric hip fractures and identify an optimal cut-off value for increased risk of lateral wall (LW) fracture when using Dynamic Hip Screw (DHS). METHODS: A comprehensive search was conducted in databases including Medline, Embase, and the Cochrane library up to July 2023. A predefined strategy was employed, with 5 eligible studies critically appraised using the methodological index for non-randomized studies (MINORS) criteria. Outcomes assessed encompassed the standardised mean difference (SMD) of LWT between the LW fracture and non LW fracture groups, aggregate LWT mean in LW fracture group, and the relation between AO/OTA fracture type with LW fracture utilising the chi-square test. RESULTS: Among 481 patients from 5 studies, 112 experienced LW fractures, while 369 did not postoperatively. Analysis indicated a significantly lower LWT in the LW fracture group (SMD -1.13, I2 = 41.3%, p = 0.146). The mean LWT in the LW fracture group was 18.2 mm, with a 95% confidence interval of 17.29-19.10 mm. CONCLUSIONS: A preoperative thin lateral femoral wall is a critical predictor of fixation failure and suboptimal functional outcomes when using a DHS. Thorough evaluation of pre- and intraoperative x-rays is essential. CMN is recommended over DHS in cases with LWT measurements <19 mm.