Type of publication:
Conference abstract

Author(s):
*Mark Garton, *Jenni Rowlands, *Richard Roach

Citation:
Abstract submitted to Bone Research Conference, 2024

Abstract:
Background: Metatarsal fractures are common and disabling fractures, frequently triggered by low-energy injuries, or less often by repetitive loading. ‘Atypical’ metatarsal fractures have also been reported during prolonged anti-resorptive therapy, but a causal relationship remains speculative. Despite their clinical and economic importance, the epidemiology of metatarsal fractures remains poorly understood. We present a detailed service evaluation of radiologically-confirmed metatarsal fractures identified within Shropshire, over a three-year period. Methods: Radiology reports for all adults (≥18 years) attending hospital or community radiology departments between May 2020 and April 2023, were searched electronically using the terms ‘metatarsal’ AND ‘fracture’. All distinct patient episodes with ≥1 confirmed metatarsal fracture were identified for further analysis, and all duplicates were excluded. Age at fracture, sex, fracture type/distribution and mechanism of injury (where known) was recorded. Age- and sex-specific fracture rates were estimated by decade of life, using contemporaneous demographic data. Results: 1121 (758 female) patient-episodes of metatarsal fracture were identified, comprising 312, 397 and 412 individuals in years 1-3 respectively. Mean (SD) age at fracture was 50.7 (18.9) years, with 961 (85.7%) metatarsal fractures occurring in isolation, most (n= 736) affecting the fifth metatarsal. Smaller numbers fractured two (n=72), three (n=63), or four (n=15) metatarsal bones. Most fractures (59%) affected the metatarsal base, and less often the shaft (26%), neck (12%) and head (3%). Fractures were most often oblique (n=410), transverse (n=359) or comminuted (n=120), and only 70 patients had stress fractures. Estimated trauma levels were low (n=632), moderate (n=109), high (n=43) and unknown (n=246), and inversion and falls-related injuries the most commonly reported mechanism. Estimated annual fracture rates per 100,000, increased from 105 among women aged 18-29 years to 153 aged 50-59 years, with a second peak of 142 aged 80-89 years. For men at the same time points, rates were 102, 40 and 31. Although numerically less frequent, metatarsal neck fractures showed the greatest sex difference, becoming exponentially more common in women with age, compared to a gradual age-related decline in men. Discussion: Metatarsal fractures are common, usually affecting the fifth metatarsal in isolation, and often caused by low energy injuries, as shown by previous authors. Lower incidence during Covid lockdown may be genuine or reflect reduced ascertainment. Our estimates of age- and sex-specific fracture rates suggest pronounced sex differences in metatarsal fracture rates with age, which requires further study and linkage to known risk factors and relevant medication exposure.

Type of publication:
Journal article

Author(s):
Nasser, Ahmed A H H; Sidhu, Manpreet; Prakash, Rohan; Mahmood, Ansar; Osman, Khabab; Chauhan, Govind S; Nandra, Rajpal; Dewan, Varun; Davidson, Jerome; Al-Azzawi, Mohammed; Smith, Christian; Gawad, Mothana; Palaiologos, Ioannis; Cuthbert, Rory; Wignadasan, Warran; Banks, Daniel; Archer, James; Odeh, Abdulrahman; Moores, Thomas; Tahir, Muaaz; Brooks, Margaret; Biring, Gurdeep; Jordan, Stevan; Elahi, Zain; Shaath, Mohammed; Veettil, Manoj; De, Chiranjit; Handford, Charles; Bansal, Mohit; Bawa, Akshdeep; Mattar, Ahmed; Tandra, Varun; Daadipour, Audrina; Taha, Ahmed; Gangoo, Shafat; Srinivasan, Sriram; Tarisai, Mandishona; Budair, Basil; Subbaraman, Krishna; Khan, Farrukh; Gomindes, Austin; Samuel, Arjun; Kang, Niel; Kapur, Karan; Mainwaring, Elizabeth; Bridgwater, Hannah; Lo, Andre; *Ahmed, Usman; *Khaleeq, Tahir; El-Bakoury, Ahmed; Rashed, Ramy; Hosny, Hazem; Yarlagadda, Rathan; Keenan, Jonathan; Hamed, Ahmed; Riemer, Bryan; Qureshi, Arham; Gupta, Vatsal; Waites, Matthew; Bleibleh, Sabri; Westacott, David; Phillips, Jonathan; East, Jamie; Huntley, Daniel; Masud, Saqib; Mirza, Yusuf; Mishra, Sandeep; Dunlop, David; Khalefa, Mohamed; Balakumar, Balasubramanian; Thibbaiah, Mahesh; Payton, Olivia; Berstock, James; Deano, Krisna; Sarraf, Khaled M; Logishetty, Kartik; Lee, George; Subbiah-Ponniah, Hariharan; Shah, Nirav; Venkatesan, Aakaash; Cheseldene-Culley, James; Ayathamattam, Joseph; Tross, Samantha; Randhawa, Sukhwinder; Mohammed, Faisal; Ali, Ramla; Bird, Jonathan; Khan, Kursheed; Akhtar, Muhammad A; Brunt, Andrew; Roupakiotis, Panagiotis; Subramanian, Padmanabhan; Bua, Nelson; Hakimi, Mounir; Bitar, Samer; Al Najjar, Majed; Radhakrishnan, Ajay; Gamble, Charlie; James, Andrew; Gilmore, Catherine; Dawson, Dan; Sofat, Rajesh; Antar, Mohamed; Raghu, Aashish; Heaton, Sam; Tawfeek, Waleed; Charles, Christerlyn; Burnand, Henry; Duffy, Sean; Taylor, Luke; Magill, Laura; Perry, Rita; Pettitt, Michala; Okoth, Kelvin; Pinkney, Thomas

Citation:
Bone & Joint Journal. 106-B(2):158-165, 2024 Feb 01

Abstract:
Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality. Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation. Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.

Altmetrics:

Type of publication:
Journal article

Author(s):
*Crooks S.A.; *Paavana T.; *Heaver C.

Citation:
Orthopaedics and Trauma. 38(1) (pp 56-64), 2024. Date of Publication: February 2024.

Abstract:
Exertional leg pain is a common problem in the athletic population, presenting with a constellation of similar symptoms. Delayed or incorrect diagnosis and treatment may result in significant morbidity and avoidable cessation of activity. Multiple causes such as chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), nerve or vascular entrapment syndromes may be responsible. A thorough history and focused clinical examination is mandated, and may yield clues as to the definitive diagnosis. Investigative adjuncts include imaging, compartment pressure measurement and electrodiagnostic studies. Whilst specific management depends on the underlying cause, the mainstay of initial management is activity modification, with surgery reserved for those who fail to respond to conservative measures.

Type of publication:
Journal article

Author(s):
*Zahra W.; *Meacher H.; *Heaver C.

Citation:
Orthopaedics and Trauma. 38(1) (pp 25-34), 2024. Date of Publication: February 2024.

Abstract:
Ankle sprains are one of the most common musculoskeletal injuries. A sprain is defined as the stretching or tearing of ligaments; in the ankle these are the lateral ligamentous complex, deltoid ligament and distal tibiofibular syndesmosis ligaments. The mechanism of injury dictates which ligaments get injured, with the most common being inversion injuries causing anterior talofibular ligamentous sprain. Initial management of an ankle sprain consists of protection, rest, ice, compression and elevation. After the first 72 hours, the treatment depends on the severity of the sprain, with physiotherapy forming the mainstay of treatment in the majority of cases. In addition to strengthening exercises proprioceptive re-training helps with rehabilitation. The goal of treatment is to prevent chronic instability from occurring. Aside from syndesmotic injuries, surgical treatment is rarely required in the acute setting. Delayed ligamentous reconstruction may be required if chronic instability occurs, and is described as being an anatomic or non-anatomical reconstruction. This article reviews the anatomy, pathophysiology, clinical assessment and management of patients with ankle sprains.

Type of publication:
Journal article

Author(s):
Ahmed H.E.; Baldock T.; Wei N.; Walshaw T.; Walker R.; Trompeter A.; Scott S.; Eardley W.G.P.; Stevenson I.; Yoong A.; Rankin I.; Dixon J.; Lim J.W.; Sattar M.; McDonald S.; Davies H.; Jones L.; Nolan M.; McGinty R.; Stevenson H.; Bowe D.; Sim F.; Vun J.; Strain R.; Giannoudis V.; Talbot C.; Gunn C.; Le H.P.D.; Bradley M.; Lloyd W.; Hanratty B.; Lim Y.; Brookes-Fazakerley S.; Varasteh A.; Francis J.; Choudhry N.; Malik S.; Vats A.; Evans A.; Garner M.; Zbaeda M.; Diamond O.; Baker G.; Napier R.; Guy S.; McCauley G.; King S.; Edwards G.; Lin B.; Davoudi K.; Haines S.; Raghuvanshi M.; Buddhdev P.; Karam E.; Nimmyel E.; Ekanem G.; Lateef R.; Jayadeep J.S.; Crowther I.; Mazur K.; Hafiz N.; Khan U.; Chettiar K.; Ibrahim A.; Gopal P.; Tse S.; Lakshmipathy R.; Towse C.; Al-Musawi H.; Walmsley M.; Aspinall W.; Metcalfe J.; Moosa A.; Crome G.; Abdelmonem M.; Lakpriya S.; Hawkins A.; Waugh D.; Kennedy M.; Elsagheir M.; Kieffer W.; Oyekan A.; Collis J.; Raad M.; Raut P.; Baker M.; Gorvett A.; Gleeson H.; Fahmy J.; Walters S.; Tinning C.; Chaturvedi A.; Russell H.; Alsawada O.; Sinnerton R.; Warwick C.; Dimascio L.; Ha T.T.; King T.; Engelke D.; Chan M.; Gopireddy R.; Deo S.; Vasarhelyi F.; Jhaj J.; Dogramatzis K.; McCartney S.; Ardolino T.; Fraig H.; Hiller-Smith R.; Haughton B.; Greenwood H.; Stephenson N.; Chong Y.; Sleat G.; Saedi F.; Gouda J.; Ravi S.M.; Henari S.; Imam S.; Howell C.; Theobald E.; Wright J.; Cormack J.; Borja K.; Wood S.; Khatri A.; Bretherton C.; Tunstall C.; Lowery K.; Holmes B.; Nichols J.; Bashabayev B.; Wildin C.; Sofat R.; Thiagarajan A.; Abdelghafour K.; Nicholl J.; Abdulhameed A.; Duke K.; Maling L.; McCann M.; Masud S.; Marshman J.; Moreau J.; Cheema K.; Rageeb P.M.; Mirza Y.; Kelly A.; Hassan A.; Christie A.; Davies A.; Tang C.; Frostick R.; Pemmaraju G.; Handford C.; Chauhan G.; Dong H.; Choudri M.J.; Loveday D.; Bawa A.; Baldwick C.; Roberton A.; Burden E.; Nagi S.; Johnson-Lynn S.; Guiot L.; Kostusiak M.; Appleyard T.; Mundy G.; Basha A.; Abdeen B.; Robertson-Smith B.; Hussainy H.A.; Reed M.; Jamalfar A.; Flintoft E.; McGovern J.; Alcock L.; Koziara M.; Ollivere B.; Zheng A.; Atia F.; Goff T.; Slade H.; Teoh K.; Shah N.; Al-Obaedi O.; Jamal B.; Bell S.; Macey A.; Brown C.; Simpson C.; Alho R.; Wilson V.; Lewis C.; Blyth D.; Chapman L.; Woods L.; Katmeh R.; Pasapula C.; Youssef H.; Tan J.; Famure S.; Grazette A.; Lloyd A.; Beaven A.; Jackowski A.; Piper D.; Lotfi N.; Chakravarthy J.; Elzawahry A.; Trew C.; Neo C.; Elamin-Ahmed H.; Ashwood N.; Wembridge K.; Eyre-Brook A.; Greaves A.; Watts A.; Stedman T.; Ker A.; Wong L.S.; Fullarton M.; Phelan S.; Choudry Q.; Qureshi A.; Moulton L.; Cadwallader C.; Jenvey C.; Aqeel A.; Francis D.; Simpson R.; Phillips J.; Matthews E.; Thomas E.; Williams M.; Jones R.; White T.; Ketchen D.; Bell K.; Swain K.; Chitre A.; Lum J.; Syam K.; Dupley L.; O'Brien S.; *Ford D.; *Chapman T.; *Zahra W.; Guryel E.; McLean E.; Dhaliwal K.; Regan N.; Berstock J.; Deano K.; Donovan R.; Blythe A.; Salmon J.; Craig J.; Hickland P.; Matthews S.; Brown W.; Borland S.; Aminat A.; Stamp G.; Zaheen H.; Jaibaji M.; Egglestone A.; Sampalli S.R.; Goodier H.; Gibb J.; Islam S.; Ranaboldo T.; Theivendran K.; Bond G.; Richards J.; Sanghera R.; Robinson K.; Fong A.; Tsang B.; Dalgleish J.; McGregor-Riley J.; Barkley S.; Eardley W.; Elhassan A.; Tyas B.; Chandler H.; McVie J.; Negus O.; Ravi K.; Qazzaz L.; Mohamed M.; Sivayoganthan S.; Poole W.; Slade G.; Beaumont H.; Beaumont O.; Taha R.; Lever C.; Sood A.; Moss M.; Khatir M.; Jeffers A.; Brookes C.; Dadabhoy M.; Bhattacharya R.; Singh A.; Beer A.; Hodgson H.; Rahman K.; Barter R.; Mackinnon T.; Frasquet-Garcia A.; Aldarragi A.; Warner C.; Pantelides C.; Attwood J.; Al-Uzri M.; Qaoud Q.A.; Green S.; Osborne A.; Griffiths A.; Emmerson B.; Slater D.; Altahoo H.; Scott H.; Rowland D.; O'Donnell J.; Edwards T.; Hafez A.; Khan B.; Crane E.; Axenciuc R.; Al-Habsi R.; McAlinden G.; Sterne J.; Wong M.L.; Patil S.; Ridha A.; Rasidovic D.; Searle H.; Choudhry J.; Farhan-Alanie M.M.; Tanagho A.; Sharma S.; Thomas S.; Smith B.; McMullan M.; Winstanley R.; Mirza S.; Hamlin K.; Elgayar L.; Larsen M.P.; Eissa M.; Stevens S.; Hopper G.P.; Fang Soh T.C.; Doorgakant A.; Yogeswaran A.; Myatt D.; Mahon J.; Ward N.; Reid S.; Deierl K.; Brogan D.; Little M.; Deakin S.; Baines E.; Jones G.; Boulton H.; Douglas T.; Jeyaseelan L.; Abdale A.; Islam A.; Atkinson K.V.; Mohamedfaris K.; Mmerem K.; Jamal S.; Wharton D.; Rana A.; McAllister R.; Sasi S.; Thomas T.; Pillai A.; Flaherty D.; Khan M.; Akkena S.; Shandala Y.; Lankester B.; Hainsworth L.

Citation:
Injury. 54(12) (no pagination), 2023. Article Number: 111007. Date of Publication: December 2023. [epub ahead of print]

Abstract:
Introduction: Current practice following injury within the United Kingdom is to receive surgery, at the institution of first contact regardless of ability to provide timely intervention and inconsiderate of neighbouring hospital resource and capacity. This can lead to a mismatch of demand and capacity, delayed surgery and stress within hospital systems, particularly with regards to elective services. We demonstrate through a multicentre, multinational study, the impact of this at scale. Methodology: ORTHOPOD data collection period was between 22/08/2022 and 16/10/2022 and consisted of two arms. Arm 1 captured orthopaedic trauma caseload and capacity in terms of sessions available per centre and patients awaiting surgery per centre per given week. Arm 2 recorded patient and injury demographics, time of decision making, outpatient and inpatient timeframes as well as time to surgery. Hand and spine cases were excluded. For this regional comparison, regional trauma networks with a minimum of four centres enroled onto the ORTHOPOD study were exclusively analysed. Result(s): Following analysis of 11,202 patient episodes across 30 hospitals we found no movement of any patient between hospitals to enable prompt surgery. There is no current system to move patients, between regional centres despite clear discrepancies in workload per capacity across the United Kingdom. Many patients wait for days for surgery when simple transfer to a neighbouring hospital (within 10 miles in many instances) would result in prompt care within national guidelines. Conclusion(s): Most trauma patients in the United Kingdom are managed exclusively at the place of first presentation, with no consideration of alternative pathways to local hospitals that may, at that time, offer increased operative capacity and a shorter waiting time. There is no oversight of trauma workload per capacity at neighbouring hospitals within a regional trauma network. This leads to a marked disparity in waiting time to surgery, and subsequently it can be inferred but not proven, poorer patient experience and outcomes. This inevitably leads to a strain on the overall trauma system and across several centres can impact on elective surgery recovery. We propose the consideration of inter-regional network collaboration, aligned with the Major Trauma System.

Altmetrics:

Type of publication:
Journal article

Author(s):
Nasser, Ahmed Abdul Hadi Harb; Prakash, Rohan; Handford, Charles; Osman, Khabab; Chauhan, Govind Singh; Nandra, Rajpal; Mahmood, Ansar; Dewan, Varun; Davidson, Jerome; Al-Azzawi, Mohammed; Smith, Christian; Gawad, Mothana; Palaiologos, Ioannis; Cuthbert, Rory; Wignadasan, Warran; Banks, Daniel; Archer, James; Odeh, Abdulrahman; Moores, Thomas; Tahir, Muaaz; Brooks, Margaret; Biring, Gurdeep; Jordan, Stevan; Elahi, Zain; Shaath, Mohammed; Veettil, Manoj; De, Chiranjit; Handford, Charles; Bansal, Mohit; Bawa, Akshdeep; Mattar, Ahmed; Tandra, Varun; Daadipour, Audrina; Taha, Ahmed; Gangoo, Shafat; Srinivasan, Sriram; Tarisai, Mandishona; Budair, Basil; Subbaraman, Krishna; Khan, Farrukh; Gomindes, Austin; Samuel, Arjun; Kang, Niel; Kapur, Karan; Mainwaring, Elizabeth; Bridgwater, Hannah; Lo, Andre; Ahmed, *Usman; Khaleeq, *Tahir; El-Bakoury, Ahmed; Rashed, Ramy; Hosny, Hazem; Yarlagadda, Rathan; Keenan, Jonathan; Hamed, Ahmed; Riemer, Bryan; Qureshi, Arham; Gupta, Vatsal; Waites, Matthew; Bleibleh, Sabri; Westacott, David; Phillips, Jonathan; East, Jamie; Huntley, Daniel; Masud, Saqib; Mirza, Yusuf; Mishra, Sandeep; Dunlop, David; Khalefa, Mohamed; Balasubramanian, Balakumar; Thibbaiah, Mahesh; Payton, Olivia; Berstock, James; Deano, Krisna; Sarraf, Khaled; Logishetty, Kartik; Lee, George; Subbiah-Ponniah, Hariharan; Shah, Nirav; Venkatesan, Aakaash; Cheseldene-Culley, James; Ayathamattam, Joseph; Tross, Samantha; Randhawa, Sukhwinder; Mohammed, Faisal; Ali, Ramla; Bird, Jonathan; Khan, Kursheed; Akhtar, Muhammad Adeel; Brunt, Andrew; Roupakiotis, Panagiotis; Subramanian, Padmanabhan; Bua, Nelson; Hakimi, Mounir; Bitar, Samer; Najjar, Majed Al; Radhakrishnan, Ajay; Gamble, Charlie; James, Andrew; Gilmore, Catherine; Dawson, Dan; Sofat, Rajesh; Antar, Mohamed; Raghu, Aashish; Heaton, Sam; Tawfeek, Waleed; Charles, Christerlyn; Burnand, Henry; Duffy, Sean; Taylor, Luke; Magill, Laura; Perry, Rita; Pettitt, Michala; Okoth, Kelvin; Pinkney, Thomas.

Citation:
Injury. 54(12):111152, 2023 Oct 24.

Abstract:
INTRODUCTION: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip. METHODS: Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period. Univariate and multivariable logistic regression analyses were performed to study the independent correlation between patient, fracture, and treatment factors on mortality. RESULTS: A total of 1,109 patients were included. The in-hospital mortality rate was 5.3%. Multivariable analyses suggested that age, male sex, abbreviated mental test score (AMTS), pneumonia, renal failure, history of peripheral vascular disease (PVD) and deep surgical site infection were each independently associated with mortality. Each yearly increase in age independently correlates with a 7% increase in mortality (OR 1.07, p=0.019). The odds of mortality was 2.99 times higher for patients diagnosed with pneumonia during their hospital stay [OR 2.99 (95% CI 1.07-8.37) p=0.037], and 7.25 times higher for patients that developed renal failure during their stay [OR 7.25 (95% CI 1.85-28.47) p=0.005]. Patients with history of PVD have a six-fold greater mortality risk (OR 6.06, p=0.003). Mode of treatment was not a significant predictor of mortality. CONCLUSION: The in-hospital mortality rate of PPFs around the hip exceeds 5%. The fracture subtype and mode of management are not independent predictors of mortality, while patient factors such as age, AMTS, history of PVD, pneumonia, and renal failure can independently predict mortality. Peri-operative optimisation of modifiable risk factors such as lung and kidney function in patients with PPFs around the hip during their hospital stay is of utmost importance.

Altmetrics: