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.

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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.

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Type of publication:
Journal article

Author(s):
*Patel R.; Mcconaghie G.; Webb J.; Laing G.; *Roach R.; Banerjee R.

Citation:
 Journal of Perioperative Practice. 34(4):106-111, 2024 Apr.

Abstract:
Polymethyl methacrylate is commonly known as bone cement and is widely used for implant fixation in various orthopaedic arthroplasty and trauma surgery. The first bone cement use in orthopaedics is widely accredited to the famous English surgeon, John Charnley, who in 1958, used it for total hip arthroplasty. Since then, there have been many developments in cementing techniques in arthroplasty surgery. This overview aims to cover the perioperative considerations of bone cement, including cementing techniques, current outcomes and complications such as bone cement implantation syndrome. The overview will additionally consider future developments involving bone cement in orthopaedic arthroplasty.

Type of publication:
Journal article

Author(s):
*Patel, Ravi; Mcconaghie, Greg; Webb, Jeremy; Laing, Georgina; Philpott, Matthew; *Roach, Richard; *Wagner, Wilhelm; *Rhee, Shin-Jae; Banerjee, Robin.

Citation:
Journal of Perioperative Practice. 34(3):84-92, 2024 Mar.

Abstract:
Throughout history, many innovations have contributed to the development of modern orthopaedic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern orthopaedic surgery: X-ray imaging, bone cement, the Thomas splint, the Pneumatic tourniquet and robotic-assisted surgery. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of orthopaedic surgery and their ongoing relevance in contemporary and perioperative practice.

Type of publication:
Journal article

Author(s):
Barrie A.; Kent B.; Jones R.; Hutton C.; Jones M.; Berry A.; Marusza C.; Reynolds P.; A'Court J.; Lum J.; Flannery O.; Knapper T.; Dela Cruz N.; Flaherty D.; Raza M.; Godavitarne C.; Ho S.; Brunt A.; Hardie J.; Taha A.; Kazzaz S.; Sri A.; Logishetty K.; Shah G.; Woods S.; Barwell J.; Marhoon Z.; Qaiyum T.; Punwar S.; Liew I.; Rooney A.; Watts D.; Kabwama S.; Townson A.; Baskaran D.; Vernon O.; Bryson D.; Stringfellow T.; Buddhdev P.; Gacaferi H.; Bretherton C.; Jordan S.; Thiruchandran G.; Mustafa Q.; Morcos Z.; Peters K.; Wilson C.; Dupley L.; Thomas A.; *Kabariti R.; Khaleeq T.; Davoudi K.; Cox I.; Cuthbert R.; Berber O.; Javed O.; Hafez A.; Garg V.; Kumar S.; O'Calloghan J.; Stanier P.; Bhalerao B.; Lokanathan S.; Sinnerton R.; Davies P.; John A.; Sreenivasan S.; Ferns J.; Bawa A.; Mattar A.; Gulihar A.; Yates J.; Al-Faqih M.; Kennedy J.; Baxter I.; Gilmore C.; Crone A.; McAlinden G.; Al-Sukaini A.; Syed S.; Tiwari I.R.; Black P.; Kang H.W.; Napier R.; Ferguson D.; Lim R.; Dott C.;

Citation:
Bone and Joint Journal. 105 B(1) (pp 82-87), 2023. Date of Publication: January 2023.

Abstract:
Aims: Management of displaced paediatric supracondylar elbow fractures remains widely debated and actual practice is unclear. this national trainee collaboration aimed to evaluate surgical and postoperative management of these injuries across the UK. Methods: this study was led by the south West Orthopaedic research division (sWOrd) and performed by the supra Man Collaborative. displaced paediatric supracondylar elbow fractures undergoing surgery between 1 January 2019 and 31 December 2019 were retrospectively identified and their anonymized data were collected via Research Electronic Data Capture (redCap). Results: A total of 972 patients were identified across 41 hospitals. Mean age at injury was 6.3 years (1 to 15), 504 were male (52%), 583 involved the left side (60%), and 538 were Gartland type 3 fractures (55%). Median time from injury to theatre was 16 hours (interquartile range (IQR) 6.6 to 22), 300 patients (31%) underwent surgery on the day of injury, and 91 (9%) underwent surgery between 10:00 pm and 8:00 am. Overall, 910 patients (94%) had Kirschner (K)-wire) fixation and these were left percutaneous in 869 (95%), while 62 patients (6%) had manipulation under anaesthetic (MUA) and casting. Crossed K-wire configuration was used as fixation in 544 cases (59.5%). Overall, 208 of the fixation cases (61%) performed or supervised by a paediatric orthopaedic consultant underwent lateral-only fixation, whereas 153 (27%) of the fixation cases performed or supervised by a non-paediatric orthopaedic consultant used lateral-only fixation. In total, 129 percutaneous wires (16%) were removed in theatre. Of the 341 percutaneous wire fixations performed or supervised by a paediatric orthopaedic consultant, 11 (3%) underwent wire removal in theatre, whereas 118 (22%) of the 528 percutaneous wire fixation cases performed or supervised by a non-paediatric orthopaedic consultant underwent wire removal in theatre. Four MUA patients (6%) and seven K-wire fixation patients (0.8%) required revision surgery within 30 days for displacement. Conclusion: the treatment of supracondylar elbow fractures in children varies across the UK. patient cases where a paediatric orthopaedic consultant was involved had an increased tendency for lateral only K-wire fixation and for wire removal in clinic. Low rates of displacement requiring revision surgery were identified in all fixation configurations.