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Bone & Joint Open
Vol. 2, Issue 10 | Pages 865 - 870
20 Oct 2021
Wignadasan W Mohamed A Kayani B Magan A Plastow R Haddad FS

Aims

The COVID-19 pandemic drastically affected elective orthopaedic services globally as routine orthopaedic activity was largely halted to combat this global threat. Our institution (University College London Hospital, UK) previously showed that during the first peak, a large proportion of patients were hesitant to be listed for their elective lower limb procedure. The aim of this study is to assess if there is a patient perception change towards having elective surgery now that we have passed the peak of the second wave of the pandemic.

Methods

This is a prospective study of 100 patients who were on the waiting list of a single surgeon for an elective hip or knee procedure. Baseline characteristics including age, American Society of Anesthesiologists (ASA) grade, COVID-19 risk, procedure type, and admission type were recorded. The primary outcome was patient consent to continue with their scheduled surgical procedure. Subgroup analysis was also conducted to define if any specific patient factors influenced decision to continue with surgery


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_9 | Pages 8 - 8
1 May 2018
Zourob E Latimer L Mohamed A Anto J Rajeev A
Full Access

Introduction

Patients with pre-existing dementia are more susceptible to hip fracture due to various risk factors such as age, decreased activity leading to sarcopenia and osteoporosis, Vitamin D deficiency and presence of Apolipoprotein gene. The mortality associated with dementia and fracture neck of femurs was thought to be 2.3 times more than that of patients with intact cognitive function. The aim of this study is to assess the mortality of patients at 28 days, 4 months and one year after undergoing surgery for fracture neck of femurs.

Methods

A retrospective study of 184 patients admitted with fracture neck of femur and had dementia for a period from April 2014 to August 2016 were carried out. The patient demographics, AMT score, pre-operative co-morbidities, perioperative mortality and one year mortality were analysed.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 310 - 310
1 Sep 2005
Giannoudis P Da Costa A Raman R Mohamed A Ng A Smith R
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Introduction and Aims: Prospective review of the patients who underwent stabilisation of displaced acetabular fractures in our unit in order to evaluate the presence of neurological lesions and functional outcome.

Method: Out of 136 patients operated over six years we identified 27 patients with neurological lesions. A standard protocol was followed for the clinical and neurophysiological evaluation of nerve injuries. Electromyography (EMG) was used to determine the anatomical location of the neurological lesions and the type of lesion, which act as a valuable tool in the diagnosis of double crush lesion in the sciatic nerve. Neurological recovery was evaluated with EMG studies and clinically rated as described by Clawson et al. Functional outcome was graded by the system proposed by Fassler and Swiontkowski.

Results: EMG studies revealed sciatic nerve lesions in all the cases. Additionally, in nine patients with a dropped foot there was evidence of a proximal (sciatic notch) and distal (neck of fibula) lesion – ‘double crush syndrome’. At final follow-up, clinical examination and associated EMG studies revealed full recovery in five cases with initial muscle weakness, and complete resolution of sensory symptoms (burning pain, hyposthesia) in four cases. There was improvement of functional capacity (motor and sensory) in two cases with initial complete drop foot and in four cases with muscle foot weakness. In 11 of the cases with dropped foot (all nine with double crush) at presentation, there was no improvement in function. Functional outcome was unsatisfactory in all patients with double crush injury.

Conclusion: In cases where there is evidence of ‘double crush lesions’ the prospect of functional recovery is low as seen in this group of patients. The patients with double crush syndrome are not expected to recover and could be considered as a sign of unfavourable outcome following neurological impairment after acetabular fractures. Single lesions appear to be associated with a more favourable prognosis.