We aimed to assess the functional outcomes of elderly patients with isolated comminuted distal humerus fractures that were managed non-operatively. Retrospective analysis of patients over 65 years presenting to our unit between 2005–2015 was undertaken. 67 patients were identified, 7 had immediate TEA, 41 died and 5 were lost to follow-up leaving 14 available for review. Mean Follow-up was 55 months(range 17–131) Patient functional outcomes were measured using VAS scores for pain at rest and during activity, and the Oxford Elbow Score (OES). Need for conversion to TEA and complications were recorded. The mean age at injury was 76 years(range 65–90) of which 79%(11/14) were females. The mean score on the OES was 46(range 29 – 48). The mean VAS score at rest was 0.4(range 0–6) and the mean VAS score during activity was 1.3(range 0–9). 93%(13/14) of patients reported no pain (0 out of 10 on the numeric scale for pain) in their injured elbow at rest and 79%(11/14) reported no pain during activity. No patients converted to TEA and there were no complications. Non-operative management of comminuted distal humerus fractures should be considered for elderly patients, avoiding surgical risks whilst giving satisfactory functional outcomes in this low demand group.
Our study aims to demonstrate the efficacy of using endobutton and interference screw technique in the repair of acute distal biceps ruptures. From April 2009 to May 2013, 25 consecutive patients had acute distal biceps tendon repairs using an endobutton and interference screw technique. 3 patients were lost to follow up leaving 22 patients for review. Mean follow up was 24 months (1–51). All were evaluated using a questionnaire, examination, radiographs, power measurements, and Oxford Elbow (OES) and MAYO scores. Overall 95% patients (21/22) felt that their surgery was successful and rated their experience as excellent or good. Mean return to work was 100 days (0–280) and mean postoperative pain relief was 23 days (1–56). 55% returned to sport at their pre-injury level. There was one case (4.5%) of heterotopic calcification with 3 superficial infections (14%). There were no intra or postoperative radial fractures, metalwork failures or metalwork soft tissue irritations. Mean pre-operative OES were 18 (6–37) and post operative 43 (24–48) (p < 0.01). Mean pre-operative Mayo scores were 48 (5–95) and post-operative 95 (80–100) (p < 0.01). Our study supports that distal biceps repairs' with endobutton and interference screw technique appears to lead to high patient satisfaction rates with a relatively early return to function.
Military patients have high functional requirements of the upper limb and may have lower pre-operative PROM scores than civilian patients i.e. their function is high when benchmarked, but still insufficient to perform their military role thereby mandating surgery. Our aim was to compare the pre-operative Oxford Shoulder Instability Scores in military and civilian patients undergoing shoulder stabilisation surgery. We undertook a prospective, blinded cohort-controlled study (OCEBM Level 3b). The null hypothesis was that there was no difference in the Oxford Shoulder Instability Scores between military and civilian groups. A power calculation showed that 40 patients were required in each group to give 95% power with 5% significance. A clinical database (iParrot, ByResults Ltd., Oxford, UK) was interrogated for consecutive patients undergoing shoulder stabilisation surgery at a single centre. The senior author - blinded to the outcome score - matched patients according to age, gender and diagnosis. Statistical analysis showed the data to be normally distributed so a paired samples t-test was used to compare the two groups. 110 patients were required to provide a matched cohort of 80 patients. There were 70 males and 10 females. Age at the time of surgery was 16–19 yrs (n=6); 20–24yrs (n=28); 25–29 (n=16); 30–34 (n=12); 35–39 (n=12); 40–44 (n=6). 72 patients (90%) had polar group one and 8 patients (10%) had polar group two instability. The mean Oxford Shoulder Instability Score in the civilian group was 17 and the in military group was 18. There was no statistical difference between the two groups (p=0.395). This study supports the use the Oxford Shoulder Instability Score to assess military patients with shoulder instability.
Skills simulation is increasingly used as a training tool in postgraduate surgical training. Trainee's perception of the value of this experience has not previously been investigated. Our aim was to investigate the value of surgical simulation training delivered by an arthroscopy skills course. We constructed a subject-specific, self-assessment questionnaire based around the ISCP Peer Assessment Tool. The questionnaire was administered to candidates before and after attending the Plymouth Arthroscopy Skills Course. Participant demographic data was recorded. Questionnaire data was interrogated to give an overview of the course, as well as the benefit of site-specific skills stations. Statistical analysis showed the data to be normally distributed. The paired T-test was used to compare mean values. Twelve surgical trainees attended the course – CT2 trainees (n=4); ST3 trainees (n=7); ST4 trainee (n=1). 11 candidates completed both administered questionnaires giving a 92% response rate. The global mean score at the beginning of the course was 2.39. The global mean score at the end of the course was 3.90. The mean improvement was 1.51 (p<0.01; 95% CI = 0.96–2.07). Skill station specific scores all showed improvement with the greatest effect in wrist arthroscopy. CT trainees had a lower mean score compared to ST trainees. Both groups completed the course with similar mean scores. This study shows that arthroscopy simulation improves trainee-reported ratings of surgical skill. It also shows that less experienced candidates derived the greatest benefit from the training. Further research is required to compare self-assessed performance against objective benchmarks using validated assessment tools.
Skills simulation is increasingly used as a training tool in postgraduate surgical training. Trainee's perception of the value of this experience has not previously been investigated. The aim of this investigation was to investigate the value of surgical simulation training delivered by an arthroscopy skills course. We constructed a subject-specific, self-assessment questionnaire based around the ISCP Peer Assessment Tool. The questionnaire was administered to candidates before and after attending the Plymouth Arthroscopy Skills Course. Participant demographic data was recorded. Questionnaire data was interrogated to give an overview of the course, as well as the benefit of site-specific skills stations. Statistical analysis showed the data to be normally distributed. The paired T-test was used to compare mean values. Twelve surgical trainees attended the course – CT2 trainees (n=4); ST3 trainees (n=7); ST4 trainee (n=1). 11 candidates completed both administered questionnaires giving a 92% response rate. The global mean score at the beginning of the course was 2.39. The global mean score at the end of the course was 3.90. The mean improvement was 1.51 (p<0.01; 95% CI= 0.96-2.07). Skill station specific scores all showed improvement with the greatest effect in wrist arthroscopy. CT trainees had a lower mean score compared to ST trainees. Both groups completed the course with similar mean scores. This study shows that arthroscopy simulation improves trainee-reported ratings of surgical skill. It also shows that less experienced candidates derived the greatest benefit from the training. Further research is required to compare self-assessed performance against objective benchmarks using validated assessment tools.
Military patients have high functional requirements of the upper limb and may have lower pre-operative PROM scores than civilian patients i.e. their function is high when benchmarked, but still insufficient to perform their military role thereby mandating surgery. Our aim was to compare the pre-operative Oxford Shoulder Instability Scores in military and civilian patients undergoing shoulder stabilisation surgery. We undertook a prospective, blinded cohort-controlled study (OCEBM Level 3b). The null hypothesis was that there was no difference in the Oxford Shoulder Instability Scores between military and civilian groups. A power calculation showed that 40 patients were required in each group to give 95% power with 5% significance. A clinical database (iParrot, ByResults Ltd., Oxford, UK) was interrogated for consecutive patients undergoing shoulder stabilisation surgery at a single centre. The senior author - blinded to the outcome score - matched patients according to age, gender and diagnosis. Statistical analysis showed the data to be normally distributed so a paired samples t-test was used to compare the two groups. 110 patients were required to provide a matched cohort of 80 patients. There were 70 males and 10 females. Age at the time of surgery was 16-19yrs (n=6); 20-24yrs (n=28); 25-29 (n=16); 30-34(n=12); 35-49(n=12); 40-44(n=6). 72 patients (90%) had polar group one and 8 patients (10%) had polar group two instability. The mean Oxford Shoulder Instability Score in the civilian group was 17 and the in military group was 18. There was no statistical difference between the two groups (p=0.395). This study supports the use the Oxford Shoulder Instability Score to assess military patients with shoulder instability.
