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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_11 | Pages 20 - 20
1 Nov 2022
Haque S Eldesoki A Lim J
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Abstract

Background

Different surgical sub specialities rely on fixed number of porters each morning to bring patients to operating theatre.

In daily morning trauma meetings usual practice is to present the whole list of one theatre and then move on to next theatre list. Once all the theatres trauma list are presented, porters are sent to get patients to theatre.

With different sub-specialities starting simultaneously and competing for fixed numbers of porters, this can cause significant delay in getting the patients to anaesthetic room.

Methods

Retrospective pilot project in level 1 major trauma centre were more that two trauma list a day is a common norm.

Pilot project:

First (Golden) patient for every trauma list would be presented at the start of the trauma meeting

Meeting would pause and consultant chairing the meeting would request the trauma theatre representative to send for these patients

Once this is done the meeting would recommence as usual


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_12 | Pages 8 - 8
1 Oct 2021
Lindsay E Lim J Clift B Cousins G Ridley D
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Unicompartmental knee osteoarthritis can be treated with either Total Knee Arthroplasty (TKA) or Unicompartmental Knee Arthroplasty (UKA) and controversy remains as to which treatment is best. UKA has been reported to offer a variety of advantages, however many still see it as a temporary procedure with higher revision rates.

We aimed to clarify the role of UKA and evaluate the long-term and revision outcomes. We retrospectively reviewed the pain, function and total Knee Society Score (KSS) for 602 UKA and 602 TKA in age and gender matched patients over ten years.

The total pre-operative KSS scores were not significantly different between UKA and TKA (42.67 vs 40.54 P=0.021). KSS (pain) was significantly better in the TKA group (44.39 vs 41.38 P= 0.007) at one year and at five years post-operatively (45.33 vs 43.12 P=0.004). There was no statistically significant difference for KSS (total) in TKA and UKA during the study period. 16.3% of UKA and 20.1% of TKA had a documented complication. 79 UKA (13%) and 36 TKA (6%) required revision surgery. Despite the higher revision rate, pre-operative KSS (total) before revision was not significantly different between UKA and TKA (42.94 vs 42.43 P=0.84). Performance for UKAs was inferior to TKAs in Kaplan-Meier cumulative survival analysis at 10 years (P<0.001).

Both UKA and TKA are viable treatment options for unicompartmental knee osteoarthritis, each with their own merits. UKA is associated with fewer complications whereas TKA provides better initial pain relief and is more durable and less likely to require revision.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_16 | Pages 7 - 7
1 Oct 2017
Dhawan R Blong J Youssef B Lim J
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The aim of this study was to assess the incidence, management and survival of unstable pelvic ring injuries in patient aged 65 years or older.

Prospectively kept data was analysed from April 2008 to October 2016. Information regarding the mechanism, fracture type, associated injuries, treatment and complications of the treatment were collected. Annual incidence was calculated and a Kaplan Meier survival analysis for carried out at 30 days, 1 year and 5 years.

404 patient records were available. 125 were 65 years or older (60 males and 65 females). 24 (19%) patients required surgical stabilisation to permit mobilisation the remaining 101 patients, treated conservatively were mobilised with immediate weight-bearing under the supervision of a physical therapist with assistive devices. Mean age was 73.5 years (SD 9.9 yrs). Fracture types were − 61.B2 47(37.6%), 61.B1 24(32%), 61.A2 17(13.6%), 61.C1 16(12.8%), 61.C2 5(4%), 61.A1 2(1.6%) and 61.C3 3(2.4%). Mechanisms of injury included fall from standing height − 41 (32%), road traffic collisions − 46(36.8%), fall from higher than standing height − 10(8%), fall from horse − 6(4.8%), jumped from bridge − 3(2.4%) & others 19(15%). Complications in surgical group included 1 death from PE and 1 wound infection treated with vacuum assisted dressing. Survivorship was 91.7%(30 days), 82.5%(1 year) and 49.7%(5 years).

Most common fracture type is 61.B2. Over one third of fractures resulted from low energy mechanism. The majority 81% could be managed conservatively. One-year survival figure closely resembles the fracture neck of femur group, highlighting the frailty of this population.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_9 | Pages 35 - 35
1 May 2017
Han F Lim J Lim C Tan B Shen L Kumar V
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Background

The traditional Kocher approach for lateral elbow exposure is often complicated by injury to the posterior interosseous nerve (PIN) and the lateral ulnar collateral ligamentous (LUCL). Kaplan approach is less commonly used, due to its known proximity to the PIN. Extensor Digitorum Communis (EDC) splitting approach allows possible wide surgical exposure and low risk of LUCL damage. The comparison of PIN injury during surgical dissection among these 3 common lateral approaches was not previously evaluated. We aim to determine the anatomical proximity of the PIN in these 3 common lateral elbow approaches and to define a safe zone of dissection for the surgical exposure.

Methods

Cadaveric dissections of 9 pairs of fresh frozen adult upper extremities were performed using EDC splitting, Kaplan and Kocher approach to the radial head sequentially in a randomised order. The radial head and PIN were exposed. A mark was made on the radial head upon the initial exposure during dissection. Measurements from the marked point of the radial head to the PIN were made. Study has been approved by the ethics committee.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_18 | Pages 6 - 6
1 Nov 2016
Lim J Foster N Ridley D Johnston L Clift B
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The use of Birmingham hip resurfacing (BHR) remains controversial due to the increased revision rate in female patients. We compared the outcomes of BHR in female patients to an age matched total hip arthroplasty(THA) cohort. We reviewed the pain, function and total Harris Hip Scores(HHS), and Kaplan-Meir survivorship for BHR and THA cohorts from a prospective regional arthroplasty database.

There were 234 patients in each cohort, with mean age of 51 years. The BHR cohort had significantly better function and total HHS at all points of the 5-year study, but not for the post-operative pain score. The 5-year revision rate for the BHR cohort was significantly higher than the THA cohort (6.8% vs 3.4%, p=0.001). The main reason for revision in the BHR cohort was aseptic loosening (n=8), followed by metallosis (n=3). The 5-year Kaplan-Meier survivorship was 92.6% (95% CI±1.7%) and 96.4% (95% CI±1.3%) for the BHR and THA cohort (p=0.001).

BHR can give significantly better functional outcomes than THA. The vast majority of female patients were happy with BHR and did not need further surgery at the 5-year stage. This is somewhat at odds with the recent reputation of the procedure. The 10-year result of the same cohort is warranted to provide further data. Our study is not a recommendation to still offer BHR to female patients, but rather to inject a note of realism into the debate. There are implications for future implant development in that these results do validate resurfacing as a functionally valuable option for active patients.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 313 - 313
1 Jul 2014
Tan J Lim J Chen Y Kumar N
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Summary

Neurological deficits resulting from spinal cord compression occur infrequently. When presented with neurological compromise, the most common management was radiotherapy, with surgery only being offered to patients who developed neurological deficit or pathological fracture resulting in unresolved severe pain post radiotherapy.

Introduction

Nasopharyngeal carcinoma has been reported to have a higher incidence of distant metastases to the spine. This study was conducted to evaluate the incidence, presentation and management of neurological involvement related to spinal metastasis from nasopharyngeal carcinoma.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_3 | Pages 6 - 6
1 Feb 2014
Lim J Cousins G Clift B
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The surgical treatment of unicompartmental knee osteoarthritis remains controversial. This study aims to compare the medium-term outcomes of age and gender matched patients treated with unicompartmental knee replacement (UKR) and total knee replacement (TKR).

We retrospectively reviewed pain, function and total knee society scores (KSS) for every UKR and age and gender matched TKR in NHS Tayside, with up to 10 years prospective data from Tayside Arthroplasty Audit Group. KSS was compared at 1, 3 and 5 years. Medical complications and joint revision were identified. Kaplan-Meier with revision as end-point was used for implants survival analysis.

602 UKRs were implanted between 2001 and 2013. Preoperative KSS for pain and total scores were not significantly different between UKRs and TKRs whereas preoperative function score was significantly better for UKRs. Function scores remained significantly better in UKRs from preoperative until 3 years follow up. Further analysis revealed no statistically significant difference in the change of function scores in both groups over time. There was a trend for TKRs to perform better than UKRs in pain scores. Total KSS for both groups were not significantly different at any point of the 5-year study. Fewer medical complications were reported in the UKR group. Kaplan-Meier analysis showed a survival rate of 93.7% in UKRs and of 97% in TKRs (Log rank p-value = 0.012).

The revision rate for UKR was twice as much as TKR. The theoretical advantages of UKR are not borne out by the findings in this study other than immediate postoperative complications.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 555 - 555
1 Sep 2012
Starks I Frost A Wall P Lim J
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The management of pelvic fractures remains a challenging problem for orthopaedic surgeons. The prompt recognition of unstable fracture patterns is important in reducing mortality and morbidity. It is perceived wisdom that a fracture of the transverse process of L5 is a predictor of pelvic fracture instability. There is a paucity of evidence in the literature to support this belief. The aim of our study was to determine if a fracture of the transverse process of L5 was a predictor of pelvic fracture instability.

The Hospital Trauma database was reviewed. Between 2006 and 2009, 65 pelvic fractures were identified. They were classified according to the Burgess and Young classification. There were 37 stable and 28 unstable fractures. 14 patients had an associated fracture of the transverse process of L5; 9 were associated with an unstable fracture pattern. The odds ratio was 3; the relative risk 1.7.

A fracture of the transverse process of L5 is associated with an increased risk of pelvic fracture instability. Its presence should alert the attending physicians to the possibility of an unstable injury.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 366 - 366
1 Sep 2012
Starks I Frost A Wall P Lim J
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The management of pelvic fractures remains a challenging problem for orthopaedic surgeons. The prompt recognition of unstable fracture patterns is important in reducing mortality and morbidity. It is perceived wisdom that a fracture of the transverse process of L5 is a predictor of pelvic fracture instability. There is a paucity of evidence in the literature to support this belief. The aim of our study was to determine if a fracture of the transverse process of L5 was a predictor of pelvic fracture instability.

The Hospital Trauma database was reviewed. Between 2006 and 2009, 65 pelvic fractures were identified. They were classified according to the Burgess and Young classification. There were 37 stable and 28 unstable fractures. 14 patients had an associated fracture of the transverse process of L5; 9 were associated with an unstable fracture pattern. The odds ratio was 3; the relative risk 1.7.

A fracture of the transverse process of L5 is associated with an increased risk of pelvic fracture instability. Its presence should alert the attending physicians to the possibility of an unstable injury.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 16 - 16
1 Jun 2012
Sharma H Lim J Reid R Reece AT
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Introduction

Spinal osteosarcomas are quite rare and the optimal treatment strategy is unknown. We report a series of 9 cases of osteosarcoma of the spine treated with intralesional resection and adjuvant combination therapy in order to evaluate their clinico-pathological correlation, recurrence rate and survival.

Materials and Methods

Between 1980 and 2009, nine histologically confirmed cases of primary conventional osteogenic sarcoma of the spine were identified from Scottish Bone Tumour Registry. This prospectively collected registry database was retrospectively reviewed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 17 - 17
1 Jun 2012
Sharma H Lim J Reid R Reece AT
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Introduction

Aneurysmal bone cysts are uncommon benign lesions affecting the spinal column. They mostly occur in the lumbar spine and have a propensity to affect adjacent vertebrae. We describe 14 aneurysmal bone cysts affecting the spinal column from the Scottish Bone Tumour Registry with regard to assess the incidence, demography, biological behaviour and recurrence rate.

Materials and Methods

We identified 14 patients with aneurysmal bone cysts affecting the spinal column. Case notes and radiographs were retrospectively reviewed from the Scottish Bone Tumour registry.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_II | Pages 148 - 148
1 Apr 2005
Lim J Luscombe K White S
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Objective: to determine if the outcome of TKR was affected by the level of pre-operative symptom severity.

Methods Between June 1998 and Nov 2001, 207 primary TKRs (AGC) were performed in 178 patients for OA of the knee. Data on patient demographics, Oxford knee score (OKS), AKSS and ABC health category were collected prospectively pre-operatively and at the 2 year review. For analysis, patients were arbitrarily categorised into four quartile groups with pre-operative OKS of 0–12, 13–24, 25–36 and 37–48.

Results The entire group had a pre-op mean OKS of 18.4. The 2 year post-op mean outcome measures were OKS 38.2 (79.6%), AKSS 87.8, Function 76.3.

Conclusion Rather than all patients achieving a uniform outcome post-TKR, patients with more severe symptoms, as indicated by lower pre-operative Oxford Knee Scores, tend to have the most to gain but achieve poorer absolute outcomes (from both patient’s (OKS) and surgeons’ perspectives (AKSS)). Conversely, at the other end of the spectrum, even patients with relatively high pre-operative OKS, (better than the units post-op mean) achieved better post-op scores . The results suggest that waiting too long before intervention compromises the final outcome.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 152 - 152
1 Feb 2003
Acornley A Lim J Dodenhoff R
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The study aimed to determine if THR deep infection rate correlated with the Nosocomial Infection National Surveillance Scheme (NINSS) data on the surgical site infection (SSI) rate in our institution.

Deep infection is a serious complication of hip replacement but presents late. It has recently been reported that 10% of superficial infections develop deep prosthetic infections. NINSS data could therefore be used to predict a unit’s infection risk. This District General Hospital has only recently entered NINSS. In the first quarter of 2001, NINSS reported an 11.9% surgical site infection rate in THRS performed in this unit.

A clinical audit of all the primary THRs done between 1/4/94 – 9/9/2001, using revision surgery as the end point, was conducted to determine the true deep infection rate. Patients were identified using the OPCS coding system database and a casenote review was performed on all revision hip operations done locally. A search for our primary THRs that underwent revision surgery at the regional tertiary referral centre was completed to avoid omissions secondary to migration.

Of 1258 primary THRS, there were 13 revisions (1%) of which 2 were done for infection (0.16%).

NINSS data placed our unit on the 90th centile for infection risk but our historical true deep infection rate of 0.16% compares favourably with the Swedish and Trent hip registry rates of 0.58% and 1.4% respectively. We therefore urge careful interpretation of NINSS data and argue against its use in the media. The quarterly reporting of SSIs may be too short to play a role in ranking hospitals but may be helpful in prophylactic antibiotic selection.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_I | Pages 71 - 72
1 Jan 2003
Lim J Dodenhoff R Acornley A
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Purpose: To evaluate the use of a steroid and local anaesthetic subacromial injection as a prognostic tool for patient recovery following arthroscopic subacromial decompression (ASD).

Methods: A prospective study of all patients seen in our unit with a clinical diagnosis of subacromial impingement syndrome was carried out between 1/00 and 9/01. All patients were diagnosed clinically, followed by a local anaesthetic/steroid subacromial injection test. In the event of a negative result to the injection test, the diagnosis was confirmed by CT arthrography or MRI scanning. All patients underwent standard ASD, with clinical evaluation via the Constant score preoperatively, at 3 weeks, 3 months, and at discharge. The eventual functional outcome was correlated with the results of the impingement test and the operative findings.

Results: One hundred and one patients (53 male, 48 female), with a mean age of 52 years (range 21–77) were entered into the study. Patients were followed up for a mean of 14 months (range 3–24). All patients had an impingement lesion noted at arthroscopy. The mean preoperative Constant score for the entire group was 48 (20–67) with a postoperative mean of 81 (46–98). 16 patients had a negative preoperative injection test. The mean improvement in this group was 21 points (47 rising to 68) compared to 35 points (48 to 83) in the positive group (p< 0.05, Mann-Whitney U test). The groups were otherwise similar for age, sex and operative findings.

Conclusions: The subacromial injection test is a useful tool both diagnostically and prognostically in patients with subacromial impingement syndrome. In patients with a confirmed diagnosis but a negative test there is still a significant improvement in the post operative Constant score, but this is of a lesser degree than in those with a positive injection test. This does not appear to be related to age, impingement grade or cuff tears, and may represent a true difference in the underlying pathology.