Trauma and orthopaedics

Improving the care of patients with obesity needing joint replacement - time for a combined ortho-bariatric approach? (2023)

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Type of publication:Conference abstract

Author(s):Sinha Y.; Ikram S.; Ballinger T.; Gouveia S.; Burak M.; Wiggins T.; *Bathgate S.;

Citation:Obesity Surgery. Conference: 14th Annual Scientific Meeting of British Obesity and Metabolic Surgery Society, BOMSS 2023. Birmingham United Kingdom. 33(Supplement 1) (pp S129), 2023. Date of Publication: July 2023.

Abstract:Introduction Patients with obesity awaiting joint replacement surgery of the lower limbs may benefit from referral to weight-management services. (1) NICE provides BMI criteria for referral to tertiary bariatric services, however this does not always translate into clinical practice. (2, 3) Our aim was to assess the number and management of patients with obesity attending orthopaedic clinics for consideration of lower limb joint replacement. Methods A retrospective analysis was undertaken of all patients attending orthopaedic clinics for joint replacement secondary to osteoarthritis, in the lower limbs, at a single centre, over a two year period. Details of demographics, BMI, comorbidities and management plans were recorded from electronic patient records. Results 335 patients (60% of 558 cases) had BMI recorded and were used for subsequent analysis. 36% (n=120) of patients were eligible for referral to weight-management services. 10% (n=32) were refused joint replacement surgery due to BMI, of which 81% (n=26) were eligible for referral to weight-management services. Instead of surgery, these 32 patients were offered: physiotherapy (n=10, 38%), analgesia (n=12, 46%), non-specific weight-loss advice (n=16, 62%), GP referral for weight-loss (n=6, 23%), and tertiary service referral for weight-loss (n=2, 8%). Conclusions BMI is an important risk factor for orthopaedic operations and increased efforts should be made to record it pre-operatively. An MDT approach would capture the notable proportion of patients who are not being appropriately referred to weight-management services which may impact on their quality of life and postoperative outcomes.

An overview of bone cement: Perioperative considerations, complications, outcomes and future implications (2024)

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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.

Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures (2023)

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Type of publication:Journal article

Author(s):*Selim, Amr; Al-Hadithy, Nawfal; Diab, Nader M; Ahmed, Abdulla Mohamed; Kader, Khaled Fawzy Abdel; Hegazy, Mohamed; Azeem, Hazem Abdel; Barakat, Ahmed Samir.

Citation:Sicotj. 9:28, 2023.

Abstract:INTRODUCTION: Lag screw cut-out is a serious complication of dynamic hip screw fixation of trochanteric hip fractures. The lag screw position has been acknowledged as one of the important factors affecting the lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesise that it could improve the reliability of predicting lag screws cut-out in these injuries. MATERIALS AND METHODS: A retrospective study was conducted for hip fracture entries in the period from Jan 2018 to July 2022. A hundred and nine patients were suitable for the final analysis. The modified TAD was measured in millimetres based on the sum of the traditional TAD in the lateral view and the net value of two distances in the AP view, the first distance is from the tip of the lag screw to the opposite point on the femoral head along the axis of the lag screw while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if inferior. A receiver operating characteristic curve was used to evaluate the reliability of the different parameters assessing the lag screw position within the femoral head. RESULTS: Reduction quality, fracture pattern as per the AO/OTA classification, TAD, Calcar Referenced TAD, Axis Blade Angle, Parker's ration in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the modified TAD had 90.1% sensitivity and 90.9% specificity for lag screw cut-out at a cut-off value of 25 mm with a P-value < 0.001. CONCLUSION: The modified TAD had the highest reliability in the prediction of lag screw cut-out. A value <= 25 mm could potentially protect against lag screw cut-out in trochanteric hip fractures.

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Five historical innovations that have shaped modern orthopaedic surgery (2024)

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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.

Supracondylar elbow fracture management (Supra Man) a national trainee collaborative evaluation of practice (2023)

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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.

Clinical outcome of open ankle fractures in patients above 70 years of age (2023)

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Type of publication:
Journal article

Author(s):
*Wajiha Zahra, *Mina Seifo, Paul Cool, *David Ford, *Tosan Okoro

Citation:
World Journal of Orthopaedics. July 2023, Vol 14(7), p. 554-561

Abstract:
BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality. However, data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal. AIM To evaluate the clinical outcomes following open ankle fracture management in patients older than 70. Our secondary aim is to look at predictors of poor outcomes. METHODS Following local research and audit department registration, 22 years of prospectively collated data from an electronic database in a district general hospital were assessed. All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified. Demographic information, the nature, and the number of surgical interventions were collated. Complications, including surgical site infection (SSI), venous thromboembolic events (VTEs) during hospital stay, and mortality rate, were reviewed. RESULTS A total of 37 patients were identified (median age: 84 years, range: 70-98); n = 30 females median age: 84 years, range: 70-97); n = 7 males median age: 74 years, range: 71-98)) who underwent surgical intervention after an open ankle fracture. Sixteen patients developed SSIs (43%). Superficial SSIs (n = 8) were managed without surgical intervention and treated with antibiotics and regular dressing changes. Deep SSIs (n = 8; 20%) required a median of 3 (range: 2-9) surgical interventions, with four patients requiring multiple washouts and one patient having metalwork removed. VTE incidence was 5% during the hospital stay. Eight patients died within 30 d, and mortality at one year was 19%. The 10-year mortality rate was 57%. The presence of a history of stroke, cancer, or prolonged inpatient stay was found to be predictive of lower survivorship in this population (log-rank test: cancer P = 0.008, stroke P = 0.001, length of stay > 33 d P = 0.015). The presence of a cardiac history was predictive of wound complications (logistic regression, P = 0.045). Age, number of operations, and diabetic history were found to be predictive of an increase in the length of stay (general linear model; age P < 0.001, number of operations P < 0.001, diabetes P = 0.041). CONCLUSION An open ankle fracture in a patient older than 70 years has at least a 20% chance of requiring repeated surgical intervention due to deep SSIs. The presence of a cardiac history appears to be the main predictor for wound complications.

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An overview of bone cement: Perioperative considerations, complications, outcomes and future implications. (2023)

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Type of publication:
Journal article

Author(s):
*Patel, Ravi; Mcconaghie, Greg; Webb, Jeremy; Laing, Georgina; *Roach, Richard; Banerjee, Robin.

Citation:
Journal of Perioperative Practice. 2023 May 26. [epub ahead of print]

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.

Provision of IV Zoledronic Acid for Neck of Femur fracture patients on Ward 4, Princess Royal Hospital (PRH), SaTH NHS Trust (2023)

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Type of publication:
Service improvement case study

Author(s):
*Dr. Sairah Anjum (FY2)

Citation:
SaTH Improvement Hub, May 2023

Abstract:
Guidance was recently approved and uploaded to the SaTH intranet (early April 2023), stating that high risk NOF fracture patients or those unable to tolerate oral bisphosphonates are more likely to benefit from a single 4mg infusion of zoledronic acid followed by 2 weeks of calcium & Vitamin D supplementation, with an overall aim of increasing bone density and reducing risk of further fragility fractures by ~50% by 10th May 2023.

Link to PDF poster [no password required]

The rise in trauma & orthopaedic trainee-led research and audit collaborative projects in the United Kingdom since the start of the COVID-19 pandemic (2023)

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Type of publication:
Journal article

Author(s):
*Khaleeq T.; *Kabariti R.; *Ahmed U.

Citation:
Pakistan Journal of Medical Sciences. 39(3) (pp 769-774), 2023. Date of Publication: May – June 2023.

Abstract:
Background and Objective: A significant increase has been observed globally in multi-centre trainee-led trauma & orthopaedic (T&O) research collaborative projects with more emphasis have been on tackling important research questions since the start of the COCID-19 pandemic. The objective of our analysis was to determine the number of trainee-led research collaborative projects in T&O in the United Kingdom that were started during the COVID-19 pandemic. Method(s): A retrospective analysis was conducted to determine how many trainee-led national collaborative projects in T&O were conducted since the start of the COVID-19 pandemic lockdown (March 2020 to June 2021) and the number of projects identified were compared to the previous year (2019). Any regional collaborative projects, projects that were started before the onset of COVID and projects of other surgical specialities were not included in the study. Result(s): There were no projects identified in 2019 while in the Covid pandemic lockdown we identified 10 trainee-led collaborative trauma & orthopaedic projects with six of them being published with level of evidence from three to four. Conclusion(s): Covid was unprecedented and has placed considerable trials across healthcare. Our study highlights an increase in multi-centre trainee-led collaborative projects within the UK and it underlines the feasibility of such projects especially with the advent of social media and Redcap which facilitate recruitment of new studies and data.

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An Assessment of Factors That Influence Outcome Following Fixation of Periprosthetic Distal Femur Fractures Associated with Total Knee Arthroplasty (2022)

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Type of publication:
Journal article

Author(s):
*Fakoya, Keji; *Sedarous, Ramy; *Seifo, Mina; *Okoro, Tosan

Citation:
Ortopedia Traumatologia Rehabilitacja. 24(3):193-199, 2022 Jun 30.

Abstract:
BACKGROUND: Periprosthetic distal femur fractures following total knee arthroplasty (PDFFTKA) are increasingly common [1], mainly in elderly patients with significant co-morbidities [2]. Surgical management usually requires balancing prompt fixation for early mobilization with the need to consider the least physiologically demanding option [3]. The aim of this study was to assess predictors of clinical and radiological outcome in patients with PDFFTKA treated with open reduction and internal fixation (ORIF). MATERIALS AND METHODS: A retrospective cohort study of patients managed for PDFFTKA over the last 21 years in the Trauma & Orthopaedics Department of the Royal Shrewsbury Hospital (RSH) was carried out. Radiological images, pre- and post-operatively, were assessed for fracture related parameters. Last known functional status was evaluated using the most recent outpatient review letters. After assessment of normality of data, evaluation of predictors of clinical and radiological outcome was made using correlation analyses. RESULTS: There was no statistically significant correlation between age, primary TKA to fracture interval, and length of intact medial cortex vs clinical outcome for the parametric variables evaluated. For non-parametric variables assessed, there was a statistically significant correlation between clinical outcome and evidence of callus formation (Spearman rho value -0.476; p=0.022). In stratifying the patients with poor and good outcome, there was no difference noted in primary TKA to fracture interval, or length of intact medial cortex (mm) between both groups. In terms of the number of comminuted fragments and anterior flange to fracture distance (mm), there was also no difference noted between the poor and good functional groups. CONCLUSIONS: 1. There was no observed correlation in pre-operative patient and fracture related variables with outcome in this population of patients with PDFFTKA. 2. Post-operative evidence of callus formation appears to be directly related to better clinical outcomes.

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