Trauma & Orthopaedics

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The influence of pre-operative Computed Tomography (CT) on surgical approach and fixation for fractures of the tibial plateau
(Elsevier, 2023-07-08) Fleming, Thomas; Torrie, Alex; Murphy, Thomas; Dodds, Alexander; Engelke, Daniel; Curwen, Christopher; Gosal, Harminder; Pegrum, James; Fleming, Thomas; Torrie, Alex; Murphy, Thomas; Alexander, Dodds; Engelke, Daniel; Curwen, Christopher; Gosal, Harminder; Pegrum, James; Medical and Dental
Background: It is well known that a computed tomography (CT) scan improves the classification of tibial plateau fractures (TPF) compared with radiographs. However, it is less clear how this translates into clinical practice. The aim of this study is to establish to what extent a pre-operative CT scan alters the approach, setup and fixation choice in TPF compared to radiographs. Methods: 50 consecutive TPF with a preoperative CT and radiographic imaging available, were assessed by 4 consultant surgeons. First, anonymised radiographs were classifying according to the column classification and the planned setup, approach, and fixation technique documented. At a 1-month interval, randomised matched CT scans were assessed and the same data collected. A tibial plateau disruption score (TPDS) was derived for all 4 quadrants (no injury = 0, split = 1, split/depression = 2 and depression = 3). Radiograph and CT TPDS were assessed using an unpaired T-test. Results: 26 female and 24 male patients, mean age 50.3, were included. Mean TPDS on radiographs and CT scans were 2.77 and 3.17 respectively. A significantly higher CT TPDS, of 0.4 (95%CI 0.10-0.71)[P = 0.0093] was observed, demonstrating that radiographs underestimate the extent of injury. The surgical approach changed in 28.5% of cases, thus influencing a change in the patient setup in theatre in 27% of cases. Identification of fractures within a column changed in 34% of cases. A high intra-observer reliability was observed when surgeons were asked to repeat their assessment in a third round at a further one month interval. Conclusion: A pre-operative CT scan has a significant effect on the approach required to fix TPF. This therefore influences the setup of the patient and can justifiably be requested as part of pre-operative planning.
The Case for Injection Therapy for Sciatica due to Lumbar Nerve Root Compression
(British Association of Spine Surgeons, 2025-03) Torrie, Alex; Torrie, Alex; Medical and Dental
No abstract available
A year in spinal surgical medicolegal (Defence) practice – an idiots’ guide
(British Association of Spine Surgeons, 2024-03) Torrie, Alex; Torrie, Alex; Medical and Dental
No abstract available
The Effect of a Simple and Reproducible Marking Technique on Enhancing Radiation Safety in Surgical Fixation of Proximal Femur Fractures
(Springer Nature, 2025-06-15) Khan, Muhammad Junaid; Juanroyee, Ahmed; Janan, Hassan; Waheed, Khawar; Mohammed, Riaz; Khan, Muhammad Junaid; Juanroyee, Ahmed; Janan, Hassan; Waheed, Khawar; Mohammed, Riaz; Medical and Dental
Introduction: Proximal femur fractures are among the most common orthopaedic injuries in the UK. Intraoperative fluoroscopy is essential for precise fracture fixation but exposes both patients and surgical teams to ionising radiation, increasing the risk of complications such as cataracts and certain cancers. While various guidelines aim to mitigate these risks, consistent implementation remains a challenge, and there is limited literature describing surgeon-led techniques to directly reduce intraoperative exposure. Methods: A case-control study was carried out at a single district general hospital in the UK, which performs over 900 hip fracture surgeries annually. The study involved 125 adult patients (aged over 18) diagnosed with AO type A1 and A2 intertrochanteric fractures, who underwent surgical treatment with either a long cephalomedullary femoral nail (Intertan) or a dynamic hip screw (DHS) between July 2020 and January 2025. Data on dose area product (DAP) and screening time were collected from dose reports archived in the Picture Archiving and Communication System (PACS) for procedures performed by two experienced trauma surgeons. The cases were categorised into two groups: one in which the operations were conducted without using the marking technique, and the other where it was applied. The study aims to evaluate the marking method’s impact on radiation exposure by comparing two groups. An observable reduction would underscore its value in enhancing radiation safety and clinical practice. Results: A significant reduction in both DAP and screening time was observed in the Intertan group using the marking technique. Mean DAP decreased by 45% from 194.47 to 105.65 UGy × m² (p = 0.0001), and mean screening time reduced from 126.30 to 92.12 seconds (p = 0.001), a reduction by 27%. The mean values for DAP and fluoroscopic exposure time were reduced in the control group for both Intertan and DHS procedures; however, the observed reduction was statistically significant only in the Intertan group. Discussion: The marking technique was effective in reducing radiation exposure during Intertan fixation without compromising surgical efficiency. It is simple, reproducible, and easy to teach, making it particularly useful in training settings and among rotating theatre teams. By streamlining fluoroscopy positioning, the technique promotes better communication with radiographers and supports adherence to the recommended principles of radiation safety. While limited by its single-centre design and small sample size, this study provides early evidence for a practical method of enhancing radiation safety in hip fracture surgery. Further research with larger cohorts is recommended to explore broader applicability and impact on operative efficiency. Keywords: fluoroscopy, fracture fixation, hip fracture, proximal femur fracture, radiation, risk reduction and prevention
Gravity assisted reduction of ankle (GARA) fractures: Results of a novel technique for relocating displaced ankle fractures in the emergency setting in comparison to traditional manipulation and reduction (TMR) technique
(Elsevier, 2022-09-29) Rangan, Raghunaathan; Mohammed, Riaz; Fenton, Paul; Bose, Deepa; Mohammed, Riaz; Medical and Dental
Background Ankle fracture displacements cause significant discomfort to the patient and can compromise soft tissues including the neurovascular structures. Prompt reduction and plaster splint application are vital in the early management of these potentially limb-threatening conditions. The process can be distressing for the patient often requiring additional personnel or equipment. We have used a novel technique of Gravity Assisted Reduction of Ankle (GARA) fractures and compared the results with the Traditional Manipulation and Reduction (TMR) technique. Material and methods With adequate analgesia, the patient turns to lay either in lateral or prone position depending on fracture pattern, thus permitting gravity to gradually aid in reduction and hold the fracture in place while Plaster Of Paris (POP) is applied. We performed a retrospective comparative study of GARA vs TMR using validated radiological parameters to assess the quality of reduction with both techniques. Results 21 patients had GARA technique, in comparison with 19 patients in TMR group. All measured radiological parameters showed similar improvement in both the groups, despite the fact that the pronation-external rotation injury pattern was more often seen in the GARA group. Intravenous sedation and monitoring were needed in 10 patients of TMR group, none in GARA group. On an average 4 personnel needed for TMR, but only 2 personnel needed for GARA technique. Conclusion Gravity assisted ankle fracture reduction is a simple, effective and reproducible alternative technique to TMR, with no need of intravenous sedation along with fewer people needed to perform the procedure.
Surgical Outcomes Following Patella Fracture Repair: A Single-Center Retrospective Cohort Study
(Springer, 2025-09-15) Feathers, Jacob; Fellows, David; Richardson, Edward; Khatir, Mohammed; George, Akhshay; Ashwood, Neil; Richardson, Edward; Medical and Dental
Introduction Patella fractures are an uncommon yet complex injury, accounting for approximately 1% of presentations to orthopedic departments. Surgical management is indicated for unstable, displaced, or comminuted fracture patterns, with the aim of restoring the extensor mechanism and preserving knee function. Various surgical techniques are available, each with differing complication profiles. This study evaluated surgical outcomes following patella fractures over a 15-year period within a single-center orthopedic department. Methods A retrospective cohort study was conducted. A single-center trauma and orthopedic database was reviewed over a 15-year period from 2008 to 2023. Inclusion criteria comprised patients presenting with patella fractures. Exclusion criteria included patients transferred to another healthcare provider for management, those lost to follow-up, or patients who did not engage with planned follow-up. Data analyzed included fracture morphology, time to surgery, surgical technique, complications, reoperation rates, and recovery duration. All patients followed a standardized physiotherapy protocol. Results A total of 100 patella fractures were included, of which 65/100 (65%) underwent surgical fixation. The mean age of patients requiring operative management was 60 years (range: 17-95), and 64.6% were female. The most prevalent fracture morphologies were transverse (44.6%) and comminuted (38.4%). The most commonly used surgical technique was tension band wiring (TBW, 64.6%), followed by cerclage wiring, partial excision with tendon repair, and cannulated screws. Across all surgical patients, the average time to recovery was 7.4 months. TBW had a mean recovery duration of 6.8 months. The shortest recovery times were observed for open reduction and internal fixation with screws (3.25 months), and the longest with excision of distal bone (24 months). Patients managed conservatively had the shortest recovery time at 2.7 months. Postoperative complications occurred in 44.6% of surgical patients. The leading complication was metalwork irritation (24.6%), which led to reoperation in 13/65 patients. Other complications included malunion, stiffness, wound infection, and non-union. There was no significant difference in recovery time between patients operated on within one day versus later. Conclusions Surgical management of patella fractures is associated with good functional outcomes; however, this study found a high rate of postoperative complications and subsequent reoperations. The most predominant reason was hardware irritation associated with TBW. These findings highlight the need for careful planning and individualization based on fracture morphology and patient factors. Recovery time is influenced by the fixation method, and current evidence on optimal postoperative recovery expectations is limited. These results underscore the need for further research to guide surgical decision-making and rehabilitation protocols.
Introduction: Closed Loop Audit Looking at How WeAre Complying with Paediatric Supracondylar Fracture (BOAST 11) Management; Results Compared With2018To2019(Full Cycle)
(Oxford University Press, 2021-05-01) Abdallah, Mohamad; Barksfield, Richard; Islam, Rabi; Barksfield, Richard; Medical and Dental
No abstract available
Early Results of Single Anaesthetic Bilateral Fixed Bearing Cemented Medial Unicompartmental Knee Replacement
(Oxford University Press, 2021-05-04) Roy, Saswata; Kiran, Manish; Atwal, Navraj; Gosal, Ha; Kiran, Manish; Atwal, Navraj; Gosal, Ha; Medical and Dental
Introduction Unicompartmental knee replacement (UKR) results in less morbidity, early mobilisation, and better PROMs in appropriately selected patients. There has been a steady increase in the number of fixed bearing UKRs in the NJR. We present the early results of single anaesthetic bilateral fixed bearing cemented medial UKR. Method All patients undergoing bilateral UKR using the ZUK prosthesis (LIMA, UK) under a single anaesthetic between March 2013 and March 2019 were included in this study. Demographic data, surgical data, change in haemoglobin after surgery and occurrence of complications were prospectively recorded in the hospital database. Pre-op and follow-up Oxford knee scores were recorded. Statistical analysis was performed using SPSS 25.0 (IBM, USA) and paired t-test was used to analyse improvement in functional score. Results Nine patients were included in this study. The mean age was 53.2years (range 43-71 years). There were 2 females and 7 males. A significant improvement in Oxford knee score from a mean of 37.2 to 53.6(p < 0.01) was seen. The mean drop in Hb was 4.1mg/dl. The mean follow up was 28 months (range 12-76 months). Conclusions There was good improvement in functional scores without any significant drop in Hb. Therefore, it is a safe and beneficial procedure.
Frailty Score Is an Independent Predictor of Outcome Following Fragility Fracture
(Oxford University Press, 2021-10-12) Brown, Robyn; Gatfield, Sophie; Rogers, Michaela; Peter, Noel; Brown, Robyn; Gatfield, Sophie; Peter, Noel; Medical and Dental
Background Frailty has been linked to greater hospitalisation, morbidity, and mortality, and is being increasingly recognised as a possible factor affecting outcomes in trauma. A 2017 TARN report identified that further research was needed to determine the effect of frailty on outcomes in trauma patients. With fragility (low energy) fractures now make up a significant burden of trauma within UK hospitals, this retrospective cohort study investigated whether frailty has a significant effect on outcomes in patients presenting with fragility fractures. Method Notes from all patients aged >60 admitted to a large District General hospital over 1 year with any fragility fracture were reviewed. Age, injury, length of stay, and mortality were recorded. A Rockwood Clinical Frailty Score (CFS) was assigned retrospectively. Results 886 patients were reviewed (male:female 266:620, mean age 82.75). CFS was independently associated with a significant increase in mortality, with every step up in CFS increasing 30-day and 1-year odds of death by 54.8% and 56.2% respectively (P < 0.001). Every step up in CFS independently increased percentage length of stay by 10.1%. Conclusions CFS independently predicts adverse outcome in hospitalised trauma patients with fragility fractures. CFS should be used routinely to identify patients at risk and may assist in allocating limited orthogeriatric resources and supporting national guidelines. Future research should investigate how resources impact outcomes for patients of varying CFS.
Introduction of A Novel Online Learning Platform Increases Junior Doctors Confidence Prior To Starting Trauma & Orthopaedic On-Calls
(Oxford University Press, 2021-10-12) Curtis, Alexander; Foster, Paul; Mutimer, Jonathan; Mutimer, Jonathan; Medical and Dental
Aim Trauma and Orthopaedic (T&O) junior doctors are expected to manage on-calls involving a high volume of patients presenting with a wide variety of complex conditions. Despite this, many junior doctors feel poorly prepared at the start of their placements with individual hospitals providing variable levels of induction. We therefore aimed to provide a free ‘Introduction to T&O on-calls’ course for junior doctors. Method The online platform ‘Zoom’ was used to provide 13 interactive lectures by T&O trainees and consultants over a single day in July 2020. In total, 280 UK junior doctors attended with 91.1% completing feedback. Pre- and post-course questionnaires were used to establish improved knowledge. Results Only 7.4% of participants either had or were aware of a local trust induction covering T&O on-calls. The course had an overall satisfaction rating of 90%, with participants showing a 15.3% improvement in on-call knowledge from pre-course to post-course (p<0.05). Prior to the course only 35% of participants felt prepared to perform an on-call which increased to 77% after the course. Almost all participants (90%) agreed that similar courses in other surgical specialties (General surgery (79%), Urology (60%), Vascular surgery (60%), ENT 55%)) which are commonly cross covered by junior doctors would be hugely beneficial. Conclusions Our principal focus moving forward is to establish a formal national induction programme for T&O junior doctors that is recognised by the relevant T&O organisations. This will instil confidence in the junior doctors whilst achieving patient safety and excellence during busy T&O on-calls.
1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures
(Oxford University Press, 2021-10-12) Hafez, Ahmed; Shaat, Ahmed; Zain, Muhammad; Butt, Ahsan; Sajid, Mohammad; Hafez, Ahmed; Medical and Dental
Aim The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach Method Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores Results There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively. Conclusions Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.
Erectile Dysfunction Following Surgical Repair of Penile Fracture: A Literature Review of Incidence, Risk Factors, and Outcomes
(Springer, 2025-09-06) Abdelrasheed, Ahmed; Elkomy, Abdelrahman; Latham, Joseph; Ali, Mohammed; Elkomy, Abdelrahman; Medical and Dental
Penile fracture is a rare urological emergency that can lead to significant complications, particularly erectile dysfunction (ED). This systematic review aimed to evaluate the incidence of ED following penile fracture and assess management strategies. A comprehensive literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across multiple databases, including PubMed, EMBASE, Cochrane, SCOPUS, and Web of Science from inception to 2024. Studies reporting on ED incidence after penile fracture and comparing different management approaches were included. Quality assessment was performed using the QUADAS-2 tool. Studies with variable or insufficient data were excluded. Twenty-four studies involving 3,213 patients were included. The overall incidence of ED after penile fracture ranged from 0% to 52.9%, with immediate surgical repair showing significantly lower rates (6.6-16.5%) compared to conservative management (45.5-52.9%). Meta-analysis revealed that immediate surgical intervention (within 24-48 hours) was associated with lower ED rates (OR: 0.36, 95% CI: 0.15-0.89, P = 0.03) compared to delayed repair. Risk factors for post-operative ED included age >50 years (RR: 1.65, 95% CI: 1.14-2.39), bilateral corporal involvement, and concomitant urethral injury. Immediate surgical repair of penile fracture is associated with lower rates of ED compared to conservative management or delayed intervention. Early recognition and prompt surgical management within 24-48 hours are crucial for optimal functional outcomes.
1419 Targeted Use of Physiotherapy Resources in The COVID Era: How Does Face to Face Physiotherapy Compare with Simple Advice Sheets After Manipulation Under Anaesthetic for Frozen Shoulder?
(Oxford University Press, 2021-10-12) Castelhano, Rute; Akehurst, Harold; Mitra, Aveek; Tasker, Andrew; Woods, David; Akehurst, Harold; Medical and Dental
Introduction This study compares two pathways for patients undergoing MUA for FS, one where physiotherapy advice is only given to the patient (Group 1), and the other where supervised hydrotherapy and physiotherapy occur post operatively (Group 2). Method A descriptive analysis of pre- and post-operative Oxford Shoulder Scores and change scores were performed. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on post-operative OSS, with pre-operative OSS as the only covariate. Results The results for post-operative OSS were significantly greater for Group 2 than for Group 1 (40.7 for NHS and 44.7 for private, improvement of 17.32 for NHS and 18.23 for Private). The effect of physiotherapy was significant (p < 0.001). The estimated effect of physiotherapy on postoperative OSS was an increase of 3.2 (95% confidence interval 1.5 – 4.8). Conclusions We detected a statistically significant increase in post-operative OSS in patients treated for frozen shoulder with MUA + physiotherapy compared with patients receiving MUA plus advice alone. These results suggest that physiotherapy does confer a real benefit, however the increased OSS is below the clinically significant level. Therefore, in a resource poor environment, such as may exist during and after COVID in many health care systems, MUA plus physio advice alone gives an excellent outcome for the treatment of FS.
Autologous cell-free serum preparations in the management of knee osteoarthritis: what is the current clinical evidence?
(Springer Nature, 2020-03-23) Angadi, Darshan; Macdonald, Hamish; Atwal, Navraj; Angadi, Darshan; Macdonald, Hamish; Atwal, Navraj; Medical and Dental
Background: There is paucity in the current literature regarding clinical outcomes of autologous cell-free serum preparations. The objective of this paper is to collate the clinical evidence and review the results of intraarticular injections of autologous cell-free serum preparations in the management of knee osteoarthritis (OA). Methods: A comprehensive English literature search was undertaken using the healthcare database website (https://hdas.nice.org.uk/). The PubMed, Medline, CINAHL, Embase and the Cochrane library databases were searched to identify all studies of autologous protein solution/autologous conditioned serum (ACS/APS) in the management of knee OA. We evaluated the reported clinical outcomes with respect to pain, function, morbidity, adverse effects and complications. Results: Fifteen relevant articles were identified in the current literature. Outcomes following injection of ACS/APS have been reported in patients with age range (34-87 years) and unilateral or bilateral knee OA. Seven studies reported improvement in visual analog scale (VAS) whereas the Western Ontario and McMaster Universities osteoarthritis instrument (WOMAC) score improved in nine studies. Considerable variation was noted in the injection technique and duration of post-procedure assessment with only one study reporting long-term follow-up beyond 24 months. Joint swelling and injection-site pain were reported to be the most common complications; only one study reported a case of septic arthritis. However, no evidence is available to clearly identify factors that may predict the outcomes following this procedure. Conclusion: Current data from the clinical studies would suggest that the intraarticular administration of autologous cell-free serum preparations, such as ACS/APS, in patients with knee OA may improve pain and function, with limited morbidity. High-quality clinical trials with stratified patient cohorts, longer follow-up duration and robust reporting of outcome measures are essential to improve the understanding of the indications and clinical effectiveness of these novel products.
Calcium phosphate injection of symptomatic bone marrow lesions of the knee: what is the current clinical evidence?
(Springer Nature, 2020-01-01) Angadi, Darshan; Edwards, Dennis; Melton, John; Angadi, Darshan; Medical and Dental
Background: Chronic bone marrow lesions (BML) in the weight-bearing portions of the knee are often associated with symptomatic degenerative arthritis resulting in pain and dysfunction. Injection of bone substitute material like calcium phosphate has been described. Whilst some studies have reported encouraging results others have shown limited benefit of this technique. Aim: The aim was to collate the available evidence on the injection of calcium phosphate and systematically evaluate the results to answer the questions encountered in clinical decision making: (1) does it provide effective long-lasting pain relief to avoid further surgical intervention? (2) which factors (patient/surgical) significantly influence the outcome? and (3) does it adversely affect the outcomes of subsequent arthroplasty? Methods: A literature search was performed to identify the studies describing the clinical outcomes of calcium phosphate injection for treatment of BML. We evaluated the reported clinical outcomes with respect to pain, function and complications. Isolated case reports and studies with no objective assessment of clinical outcomes were excluded. Results: We noted 46 articles in the current literature of which 8 described clinical outcomes of calcium phosphate injection. Mean (plus/minus SD) score on the visual analog scale (VAS) has been reported to improve from 7.90 (± 0.38) to 2.76 (± 0.90), whereas the International Knee Documentation Committee (IKDC) score improved from 30.5 (SD not reported (NR)) to 53.0 (SD NR). Pre and post procedure Short form survey (SF-12) scores were 29.8 (SD NR) and 36.7 (SD NR), respectively. In one study, scores on the Tegner Lysholm knee scoring scale improved in 12 out of 22 patients, whereas the remainder had no change in symptoms. Extravasation of calcium phosphate into the joint was the most common complication, whereas no adverse effect has been reported on subsequent arthroplasty. Conclusion: Limited data from the published studies would suggest that calcium phosphate injection of BML may potentially improve pain and function. However, no evidence is currently available to clearly identify patient/surgical factors that may influence the long-term outcomes of this procedure. Hence pragmatic, prospective studies with stratified patient cohorts and robust reporting of outcome measures are essential to improve the understanding of the indications and clinical effectiveness of this novel procedure.
Safety Considerations in 3D Bioprinting Using Mesenchymal Stromal Cells
(Frontiers Media, 2020-10-08) Belk, Lucy; Tellisi, Nazzar; Macdonald, Hamish; Erdem, Ahmet; Ashammakhi, Nureddin; Pountos, Ippokratis; Macdonald, Hamish; Medical and Dental
Three-dimensional (3D) bioprinting has demonstrated great potential for the fabrication of biomimetic human tissues and complex graft materials. This technology utilizes bioinks composed of cellular elements placed within a biomaterial. Mesenchymal stromal cells (MSCs) are an attractive option for cell selection in 3D bioprinting. MSCs can be isolated from a variety of tissues, can pose vast proliferative capacity and can differentiate to multiple committed cell types. Despite their promising properties, the use of MSCs has been associated with several drawbacks. These concerns are related to the ex vivo manipulation throughout the process of 3D bioprinting. The herein manuscript aims to present the current evidence surrounding these events and propose ways to minimize the risks to the patients following widespread expansion of 3D bioprinting in the medical field.
127 Standardising Access to Fracture Fixation Simulation for Core Surgical Trainees
(Oxford University Press, 2021-05-04) Brown, Robyn; Curwen, Christopher; Mutimer, Jonathan; Brown, Robyn; Curwen, Christopher; Mutimer, Jonathan; Medical and Dental
Introduction Simulation is increasingly being used to augment clinical experience. However, access to simulation varies geographically and national courses can be costly. The Severn School of Surgery aimed to provide a locally run, cost-neutral “Basic Principles in Fracture Fixation” course to standardise access to simulation for core surgical trainees (CSTs). Method The course ran from a district general hospital, accommodating lectures, case discussions, and practical stations (screw fixation, plate fixation, dynamic hip screw, and external fixation). Faculty donated their time and a devices company provided kit and dry bones. CSTs organised the course. Pre- and post-course self-rated Intercollegiate Surgical Curriculum Programme (ISCP) global competency ratings in the practical stations were recorded and usefulness of aspects of the course was recorded. Results 32 candidates attended. Mean self-rated competency increased by at least one global rating in all practical stations (p < 0.05). All aspects of the course were deemed useful (pre-course reading by 27/28, lectures by 31/32, and case discussions by 31/32). No net cost was incurred. Conclusions Increases in self-rated competency in surgical skills can be obtained through a cost-neutral, trainee-organised, regional skills course. Pre-course reading, lectures, case discussions, and practical sessions are all useful. This model can be used by others to standardise the simulation curriculum.
Parsonage Turner syndrome caused by Staphylococcus aureus spondylodiscitis
(BMJ Publishing Group, 2020-02-13) Brown, Robyn; O'Callaghan, Jamie; Peter, Noel; Brown, Robyn; O'Callaghan, Jamie; Peter, Noel; Medical and Dental
Parsonage Turner syndrome (otherwise known as PTS, neuralgic amyotrophy or acute brachial neuritis) is a rare, but clinically significant cause of atraumatic shoulder girdle pain and weakness. Diagnosis is primarily clinical and can be challenging due to its heterogeneous presentation. A case of PTS following systemic infection from Staphylococcus aureus spondylodiscitis is presented. Timely consideration of the diagnosis prevented unnecessary investigation and allowed effective rehabilitation. This is the first case of PTS preceded by S. aureus infection. PTS should be considered in those presenting with acute, atraumatic shoulder dysfunction after systemic infection.
Comparison of survivorship and performance of a platform shoulder system in anatomic and reverse total shoulder arthroplasty
(Elsevier, 2020-07-27) Flurin, Pierre; Tams, Carl; Simovitch, Ryan; Knudsen, Christopher; Roche, Christopher; Wright, Thomas; Zuckerman, Joseph; Schoch, Bradley; Knudsen, Christopher; Medical and Dental
Background Contemporary studies note sustained clinical benefit and decreasing complications after reverse total shoulder arthroplasty (RTSA), which warrant a comparison with the standard anatomic total shoulder arthroplasty (ATSA). The purpose of this study is to evaluate and compare differences in midterm survivorship between ATSA and RTSA patients treated with a single platform shoulder prosthesis. Secondary objectives include a comparison of the clinical outcomes and complication profile for each procedure. Methods A prospective analysis of all primary ATSA and RTSA performed by 3 surgeons between 2007 and 2012 was conducted. Selection of the ATSA or RTSA implant configuration was determined by the surgeons per their clinical understanding of each individual patient's glenoid morphology, rotator cuff, and patient expectations. All 778 procedures were performed using a single platform shoulder system. Results Survivorship for ATSA was similar to that for RTSA at all time points; ATSA at 2 and 8 years was 98.5% and 96.0%, whereas RTSA at 2 and 8 years was 98.7% and 96.0%, respectively ( P= .392). All postoperative range of motion scores for ATSA patients were greater than those for RTSA patients. The overall rate of complications between the ATSA and RTSA groups was similar (6.3% vs. 4.9%, P= .414). Conclusions On the basis of this cohort comparison, both ATSA and RTSA demonstrated similar survivorship at 8 years after surgery with multiple surgeons practicing in different countries. Our results demonstrate that the RTSA and ATSA implants have comparable results and can be expected to provide similar implant longevity over the midterm with excellent functional outcomes.
Using a Wearable Activity Monitor to Accurately Measure Mobility After Surgery for Hip Fractures (MASH)-A Feasibility Study Protocol
(SAGE Publications, 2020-11-12) Berwin, James; Macdonald, Hamish; Fleming, Tom; Kempshall, Peter; Engelke, Daniel; Berwin, James; Macdonald, Hamish; Fleming, Tom; Kempshall, Peter; Engelke, Daniel; Medical and Dental
Introduction: Hip fractures are the most common reason for acute orthopaedic admission in the United Kingdom (UK) and pose a substantial cost to the National Health Service (NHS). A significant proportion of this expenditure is accounted for by hospital bed days, with additional contributions from health and social aftercare. Early ambulation following hip fracture surgery improves outcomes by accelerating functional recovery and reducing the need for ongoing care. The ability to track a patient's rehabilitation is important in assessing their care needs. While this is challenging to assess accurately, doing so may help to further improve outcomes. The aim of this feasibility study is to determine whether it is possible to accurately measure Mobility After Surgery for Hip fractures (MASH) in the immediate post-operative period by tracking the frequency of mobilization, distance walked and overall activity in the first week following surgery using a wearable activity monitor, the activPAL device. Methods and materials: A total of 50 patients will be recruited to participate in the study. Ethical approval was given to recruit patients with and without capacity to consent. Immediately after undergoing hip fracture surgery, a activPAL monitor weighing 9 grams and measuring 23.5 mm x 43 x 5 mm in size will be applied to the anterior aspect of the participants thigh with a standard adhesive dressing. We will be assessing the feasibility of using the activPALto measure mobility in this patient group. Discussion: The MASH study will contribute to the design and execution of the MASH trial, which will seek to assess the accuracy by which mobility can be measured following hip fracture surgery and how this information can best be used to improve rehabilitation and care.

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