Aims. Body exhaust suits or surgical helmet systems (colloquially, ‘space suits’) are frequently used in many forms of arthroplasty, with the aim of providing personal protection to surgeons and, perhaps, reducing periprosthetic joint infections, although this has not consistently been borne out in systematic reviews and registry studies. To date, no large-scale study has investigated whether this is applicable to shoulder arthroplasty. We used the New Zealand Joint Registry to assess whether the use of surgical helmet systems was associated with lower all-cause revision or revision for deep infection in primary shoulder arthroplasties. Methods. We analyzed 16,000 shoulder arthroplasties (hemiarthroplasties, anatomical, and reverse geometry prostheses) recorded on the New Zealand Joint Registry from its inception in 2000 to the present day. We assessed patient factors including age, BMI, sex, and American Society of Anesthesiologists (ASA) grade, as well as whether or not the operation took place in a laminar flow operating theatre. Results. A total of 2,728 operations (17%) took place using surgical helmet systems. Patient cohorts were broadly similar in terms of indication for surgery (osteoarthritis, rheumatoid arthritis, fractures) and medical comorbidities (age and sex). There were 842 revisions (5% of cases) with just 98 for deep infection (0.6% of all cases or 11.6% of the revisions). There were no differences in all-cause revisions or revision for deep infection between the surgical helmet systems and conventional gowns (p = 0.893 and p = 0.911, respectively). Conclusion. We found no evidence that wearing a surgical helmet system reduces the incidence of periprosthetic joint infection in any kind of primary shoulder arthroplasty. We acknowledge the limitations of this registry study and accept that there may be other benefits in terms of personal protection, comfort, or visibility. However, given their financial and ecological footprint, they should be used judiciously in shoulder surgery. Cite this article: Bone Jt Open 2024;5(10):894–897

Aims. The surgical helmet system (SHS) was developed to reduce the risk of periprosthetic joint infection (PJI), but the evidence is contradictory, with some studies suggesting an increased risk of PJI due to potential leakage through the glove-gown interface (GGI) caused by its positive pressure. We assumed that SHS and glove exchange had an impact on the leakage via GGI. Methods. There were 404 arthroplasty simulations with fluorescent gel, in which SHS was used (H+) or not (H-), and GGI was sealed (S+) or not (S-), divided into four groups: H+S+, H+S-, H-S+, and H-S-, varying by exposure duration (15 to 60 minutes) and frequency of glove exchanges (0 to 6 times). The intensity of fluorescent leakage through GGI was quantified automatically with an image analysis software. The effect of the above factors on fluorescent leakage via GGI were compared and analyzed. Results. The leakage intensity increased with exposure duration and frequency of glove exchanges in all groups. When SHS was used and GGI was not sealed (H+S-), the leakage intensity via GGI had the fastest increase, consistently higher than other groups (H+S+, H-S+ and H-S-) after 30 minutes (p < 0.05) and when there were more than four instances of glove exchange (p < 0.05). Additionally, the leakage was strongly correlated with the duration of exposure (r. s. = 0.8379; p < 0.050) and the frequency of glove exchange (r. s. = 0.8198; p < 0.050) in H+S-. The correlations with duration and frequency turned weak when SHS was not used (H-) or GGI was sealed off (S+). Conclusion. Due to personal protection, SHS is recommended in arthroplasties. Meanwhile, it is strongly recommended to seal the GGI of the inner gloves and exchange the outer gloves hourly to reduce the risk of contamination from SHS. Cite this article: Bone Jt Open 2023;4(11):859–864

Introduction. Infection is disastrous in arthroplasty surgery and requires multidisciplinary treatment and debilitating revision surgery. Between 80-90% of bacterial wound contaminants originate from colony forming units (CFUs) present in operating room air, originating from bacteria shed by personnel present in the operating environment. Steps to reduce bacterial shedding should reduce wound contamination. These steps include the use of unidirectional laminar airflow systems and the introduction of theatre attire modelled on this principle (e.g. total body exhaust suits). Our unit introduced the use of the Stryker Sterishield Personal Protection System helmet used with laminar flow theatre systems. This study compares an enclosed helmet system used with standard gowns, with standard hood and mask attire. Method. 12 simulated hip arthroplasties were performed, six using disposable sterile impermeable gown, hood and mask and a further 6 using a Sterishield helmet and hood. Each 20 minute operation consisted of arm and head movements simulating movements during surgery. Air was sampled at wound level on a sterile draped operating table using a Casella slit sampler, sampling at 700l/minute. Samples were incubated on Blood agar for 48 hours at 37°c and the CFUs grown were counted. Results. Mean number of CFUs for the helmet was 9.33 with hood and mask attire having 49.16 CFUs (S. Ds 6.34 and 26.17; p value 0.0126). In all cases a coagulase negative staphylococcus was isolated. Conclusion. Although the sample size was small, we demonstrated a fivefold increase in the number of CFUs shed when using hood and mask attire compared to personal helmet and sterile hood. We conclude that the helmet system is superior to non-sterile hood and mask at reducing bacterial shedding by theatre personnel

Introduction Infection is a disastrous complication of arthroplasty surgery, requiring multidisciplinary treatment and debilitating revision surgery. As between 80–90% of bacterial wound contaminants originate from colony forming units (CFU’s) present in operating room air tending to originate from bacteria shed by personnel present within the operating environment, any steps that can reduce this bacterial shedding should reduce the chances of wound contamination. These steps have included the use of unidirectional downward laminar airflow theatre systems, and the introduction of theatre attire modelled on this principle (e.g. total body exhaust suits). Our unit has introduced the use of the Stryker T4 Personal Protection System helmet in conjunction with laminar flow theatre systems. This study compares an enclosed helmet system used with standard gowns, with standard hood & mask attire. Method 12 simulated hip arthroplasty operations were performed, six using disposable sterile impermeable gown, hood and mask, with a further 6 using the T4 helmet & hood. Each 20 minute operation consisted of a series of arm and head movements simulating movements performed during surgery. Air was sampled at wound level on a sterile draped operating table using a Casella slit sampler, sampling at 700l/minute. Samples were incubated on Blood agar for 48 hours at 37oc & the CFU’s grown were counted. Results The mean number of CFU’s for the helmet was 9.33 with hood and mask attire yielding 49.16 CFU’s (S.Ds 6.34 & 26.17; p value 0.0126). In all cases, the organism isolated was a coagulase negative staphylococcus. Conclusion Although the sample size was small, we demonstrated a fivefold increase in the number of CFU’s shed when using hood and mask attire compared to personal helmet and sterile hood. We conclude that the helmet system is superior to non-sterile hood & mask at reducing bacterial shedding by theatre personnel

Introduction Infection is a disastrous complication of arthroplasty surgery, requiring multidisciplinary treatment and debilitating revision surgery. As between 80–90% of bacterial wound contaminants originate from colony forming units (CFU’s) present in operating room air tending to originate from bacteria shed by personnel present within the operating environment, any steps that can reduce this bacterial shedding should reduce the chances of wound contamination. These steps have included the use of unidirectional downward laminar airflow theatre systems, and the introduction of theatre attire modelled on this principle (e.g. total body exhaust suits). Our unit has introduced the use of the Stryker Sterishield Personal Protection System helmet in conjunction with laminar flow theatre systems. This study compares an enclosed helmet system used with standard gowns, with standard hood & mask attire. Method 12 simulated hip arthroplasty operations were performed, six using disposable sterile impermeable gown, hood and mask, with a further 6 using a Sterishield helmet & hood. Each 20 minute operation consisted of a series of arm and head movements simulating movements performed during surgery. Air was sampled at wound level on a sterile draped operating table using a Casella slit sampler, sampling at 700l/minute. Samples were incubated on Blood agar for 48 hours at 37°c & the CFU’s grown were counted. Results The mean number of CFU’s for the helmet was 9.33 with hood and mask attire having 49.16 CFU’s (S.Ds 6.34 & 26.17; p value 0.0126). In all cases, the organism isolated was a coagulase negative staphylococcus. Conclusion Although the sample size was small, we demonstrated a fivefold increase in the number of CFU’s shed when using hood and mask attire compared to personal helmet and sterile hood. We conclude that the helmet system is superior to non-sterile hood & mask at reducing bacterial shedding by theatre personnel

Background. Sterile Surgical Helmet System (SSHS) are used routinely in hip and knee arthroplasty in order to decrease the risk of infection. It protects surgeon from splash and also prevents contamination of surgical field from reverse splash by virtue of its perceived sterility. A prospective study was conducted to confirm if SSHS remain sterile throughout the procedure in Hip (THA) and Knee (TKA) Arthroplasty. We also evaluated if type of theatre had any effect on degree of contamination. Material and Methods. Visor area of 40 SSHS was swabbed at half hourly interval until the end of the procedure. Two groups of 20 each were made on the basis of theatre used for performing surgery. Group 1 (Gp1) had surgery performed in laminar flow and Group 2 (Gp2) in non-laminar flow theatre. Swabs collected were processed to compare the time dependent contamination of the SSHS and identify the organisms responsible for contamination. Results. Overall 80% (70% laminar, 90% non-laminar) of masks were contaminated by end of the procedure. There was a statistically significant difference in degree of contamination after direct inoculation while there was no statistical difference after 24 hrs of incubation. Coagulase negative Staphylococcus was the most common bacteria grown in both the groups. Conclusion. SSHS lose their sterility peroperatively due to airborne contamination, mandating prompt change of gloves in case of active contact with them to avoid the bacterial transmission into surgical wound and catastrophic joint infection

Introduction. Surgical spacesuits are in widespread use. Only one previous study (JBJS 1998) has assessed the quality of the environment within the space suit. They demonstrated that surgical spacesuits could allow re-breathing of carbon dioxide (CO. 2. ). However, they had no control group and performed a vigorous exercise protocol which may have been an unfair test. The design of helmet systems has also evolved in the last decade. We have conducted the first investigation into CO. 2. levels inside the modern space suit. There is a Workplace Exposure Limit for inspired CO. 2. as determined by the Health and Safety Executive (UK), which is 0.506kPa. We wondered whether re-breathing of CO. 2. in space suits would lead to inspired CO. 2. which breaches this level. Methods. We used an anaesthetic room gas analyzer via nasal cannulae to measure inspired (ICO. 2. ) levels in 12 healthy volunteers. Readings were taken while wearing a surgical space suit with the fan on high and low settings. These were compared with a normal surgical facemask. Readings were repeated on mild exertion to simulate the effort of performing arthroplasty surgery. Results. [Frequency of ICO2 >0.5kPa (12 subjects)]. Discussion. Despite the design modifications, modern space suits allow re-breathing of CO. 2. This is more marked with exertion and with low fan settings where ICO. 2. can exceed workplace limits. This may account for symptoms of headache and drowsiness reported after a prolonged period in the suit during arthroplasty surgery. We recommend the use of high fan settings at all times

Deep infection occurs in 2–4% of lower limb arthroplasty resulting in increasing cost, co-morbidity and challenging revision arthroplasty surgery. Identifying the potential sources of infection helps reduce infection rates. The aim of our study is to identify the impact and potential for contamination of our hands and gowns whilst scrubbing using SSHS.

A colony-forming unit (CFU) is a pathogenic particle of 0.5 micrometers to 5 micrometers. Concurrent particle counts and blood agar exposure settle plates for 3 subjects and 1 alcohol cleaned mannequin; testing a standard arthroplasty hood, a SSHS with and without the fan on for a 2 minute exposure to represent scrubbing time. Microbiological plates were incubated using a standard protocol by our local microbiology department.

All SSHS were positive for gram-positive cocci with a mean colony count of 410cfu/m². Comparing background counts for laminar flow (mean 0.7 particle/m³; 95% CI 0–1.4) versus scrub areas (mean 131.5 particle/m3; 95% CI 123.5–137.9; p=0.0003), however neither grew any CFU's with a 2-minute exposure. For the mannequin, the only significant result was with the fan on with a 1.5× increase in the particle count (p=0.042) and a correlating positive organism (13CFU/m²). With human subjects, however, the particle count increased by 3.75× the background count with the fan on (total p=0.004, CFU p=0.047) and all had positive cultures, mean 36 CFU/m². There were no positive cultures with the standard arthroplasty hood or the SSHS with no fan on. If repeated in laminar flow, there was only a statistically significant increase with the fan on (p=0.049), but with negative cultures following a 2-minute exposure.

Sterile gloves and gowns can be contaminated when scrubbing with the SSHS fan on. We recommend having the fan switched off when scrubbing until the hood and gown is in place, ideally in a laminar flow environment.

Aims. Due to the recent rapid expansion of scooter sharing companies, there has been a dramatic increase in the number of electric scooter (e-scooter) injuries. Our purpose was to conduct a systematic review to characterize the demographic characteristics, most common injuries, and management of patients injured from electric scooters. Methods. We searched PubMed, EMBASE, Scopus, and Web of Science databases using variations of the term “electric scooter”. We excluded studies conducted prior to 2015, studies with a population of less than 50, case reports, and studies not focused on electric scooters. Data were analyzed using t-tests and p-values < 0.05 were considered significant. Results. We studied 5,705 patients from 34 studies. The mean age was 33.3 years (SD 3.5), and 58.3% (n = 3,325) were male. The leading mechanism of injury was falling (n = 3,595, 74.4%). Injured patients were more likely to not wear a helmet (n = 2,114; 68.1%; p < 0.001). The most common type of injury incurred was bony injuries (n = 2,761, 39.2%), of which upper limb fractures dominated (n = 1,236, 44.8%). Head and neck injuries composed 22.2% (n = 1,565) of the reported injuries, including traumatic brain injuries (n = 455; 2.5%), lacerations/abrasions/contusions (n = 500; 7.1%), intracerebral brain haemorrhages (n = 131; 1.9%), and concussions (n = 255; 3.2%). Standard radiographs comprised most images (n = 2,153; 57.7%). Most patients were treated and released without admission (n = 2,895; 54.5%), and 17.2% (n = 911) of injured patients required surgery. Qualitative analyses of the cost of injury revealed that any intoxication was associated with higher billing costs. Conclusion. The leading injuries from e-scooters are upper limb fractures. Falling was the leading mechanism of injury, and most patients did not wear a helmet. Future research should focus on injury characterization, treatment, and cost. Cite this article: Bone Jt Open 2022;3(9):674–683

Orthopaedic surgical hoods rely on an intrinsic fan to force clean external air over the wearer and allow potentially contaminated and expired air to flow down and away from the surgical field. Carbon dioxide (CO. 2. ) is produced through aerobic metabolism and can potentially accumulate inside the hood. Levels above 2500ppm have been shown to affect cognitive and practical function in flight simulator studies. Maximum Health and Safety Executive (HSE) 8-hour exposure limit is 5000ppm There is a paucity of data on real-world CO. 2. levels experienced during arthroplasty surgery whilst wearing a hood. CO. 2. levels were continuously recorded during 31 elective arthroplasties, both primary and revision. Data was collected for surgeon and assistant. Data was recorded at 0.5Hz throughout the procedure utilising a Bluetooth CO. 2. detector, worn inside a Stryker Flyte. ™. surgical helmet worn with a toga gown. Four surgeons contributed real time data to the study. This data was augmented with experimental data, investigating varying fan speeds and activity levels. Median operative duration was 82 minutes (range 36–207). The average CO. 2. level across all procedures was 2952ppm, with 22 of the cases having a mean above 2500ppm, but none having a mean above 5000ppm. For each procedure, the time spent above 2500 and 5000 ppm was calculated, with the average being 68.4 % and 5.6% respectively. The experimental data demonstrated higher CO. 2. levels with lower fan speed, and at higher activity levels, and levels exceeding 15000 ppm during gentle exercise. During operative cases, low fan speed cases did have a marginally higher mean CO. 2. value than high fan speed (3033.02 and 2903.56 respectively) but the small numbers of cases (n=10) where this data was captured limit the relevance of this difference. The use of surgical helmets for elective orthopaedic surgery, can results in CO. 2. levels regularly rising to a point which may affect cognitive function. This study recommends the use of a higher fan speed where possible to minimise the risk of such CO. 2. levels, and recommends further research in this area

Trauma patients present with different injuries and some of them require emergency surgical procedures. Orthopaedic department at Steve Biko Academic Hospital (SBAH) have seen an increasing number of patients presenting with serious orthopaedic injuries due to Delivery Motorbike Accidents (DMBA). The aim of the study was to establish the epidemiology and pattern of orthopaedic injuries sustained following Delivery Motorbike Accident. Motor Vehicle Accident (MVA) administration office at SBAH in emergency department was approached for patients registers used between 1 January 2020 and 31 December 2022. There patients were registered as Motor Vehicle Accident (MVA), Motorbike Accident (MBA) and Pedestrian Vehicle Accident (PVA) by the administration office. The details of patients classified as MBA were collected and used to obtain clinical data from medical and radiological records in the form of patient's files and PACS respectively. Approximately 240 patients presented to Emergency department with orthopaedic injuries following a motorbike accident. About 78 files could not be retrieved from the patient's records department. About 74patients had their occupation recorded as unknown or unemployed. Approximately 70 patients had their occupation indicated in the file by the Clinicians or Administration Clerks. About 40 patients had their occupation as delivery man or working for a delivery company. 16 patients did not have images on the PACS system. Most of the patients were males, presented after hours and sustained multiple injuries that were managed surgically. Very few patients had their helmet status indicated in the file. The study suggests that accidents due to delivery motorbikes are prevalent at SBAH and result in orthopaedic injuries. Almost 50% of patients who had their occupation indicated in the file were delivery employees. A follow up prospective study is recommended to ensure complete collection of data from patients at presentation to ED

The use of exhaust suit systems is commonplace in arthroplasty surgery where isolation of the surgical team is desirable in an attempt to reduce the risk of infection transmission. Elevated carbon dioxide levels have been reported in the non-clinical setting with such systems the consequences of which can include fatigue, diapho-resis, nausea, headache and irritability. The aim of our study was to determine the levels of carbon dioxide present within an exhaust suit system during hip arthroplasty and to compare these with the recommended occupational exposure limit levels published by the Health and Safety Executive (HSE). Data was collected during ten primary hip replacements performed by the same surgeon whilst wearing the Stryker Steri-Shield Helmet Exhaust System. This is a self-contained unit with an integrated blower used in conjunction with a full-length gown. In addition the helmet was fitted with an air-sampling probe connected to a portable infrared CO2 monitor and also a temperature probe. Thus continuous monitoring of both CO2 and temperature level during surgery was possible. The mean initial CO2 concentration in the helmet at the beginning of surgery was 3 000 parts per million (ppm) and the mean maximum CO2 level recorded was 13 000 ppm. The mean time the surgeon was within an exhaust suit to perform a primary hip replacement was 1 hr 54 mins and for 86% of this time period the CO2 level within the helmet exceeded the recommended level of 5 000 ppm as stipulated by the HSE. In conclusion we have demonstrated significantly elevated CO2 levels within the Stryker Steri-shield Exhaust Suit System during hip surgery. Surgeons who use this system should be aware of this together with the physical symptoms that may result

The use of exhaust suit systems is commonplace in arthroplasty surgery where isolation of the surgical team is desirable in an attempt to reduce the risk of infection transmission. Elevated carbon dioxide levels have been reported in the non-clinical setting with such systems the consequences of which can include fatigue, diaphoresis, nausea, headache and irritability. The aim of our study was to determine the levels of carbon dioxide present within an exhaust suit system during hip arthroplasty and to compare these with the recommended occupational exposure limit levels published by the Health and Safety Executive (HSE). Data was collected during ten primary hip replacements performed by the same surgeon whilst wearing the Stryker Steri-Shield Helmet Exhaust System. This is a self-contained unit with an integrated blower used in conjunction with a full-length gown. In addition the helmet was fitted with an air-sampling probe connected to a portable infrared CO. 2. monitor and also a temperature probe. Thus continuous monitoring of both CO. 2. and temperature level during surgery was possible. The mean initial CO. 2. concentration in the helmet at the beginning of surgery was 3000 parts per million (ppm) and the mean maximum CO. 2. level recorded was 13,000 ppm. The mean time the surgeon was within an exhaust suit to perform a primary hip replacement was 1 hr 54 mins and for 86% of this time period the CO. 2. level within the helmet exceeded the recommended level of 5000 ppm as stipulated by the HSE. In conclusion we have demonstrated significantly elevated CO. 2. levels within the Stryker Steri-shield Exhaust Suit System during hip surgery. Surgeons who use this system should be aware of this together with the physical symptoms that may result

The number of skate related injuries has seen a resurgence in the western world with almost 51000 patients in 1999 presenting to US hospitals with a skateboard related injury, almost 90% of these being male and almost 70% of these are orthopaedic related injuries. Protection , particularly wrist guards, elbow pads, knee pads and recognized helmets are all necessary in protecting the young child against orthopaedic injuries. However despite these physical barriers little training or supervision exists in adequately educating children as to the dangers of these devices. Having observed an increased number of referrals to our Accident and Emergency Dept with fractures sustained whilst roller-blading and skateboarding we set about prospectively evaluating the epidemiology and nature of such injuries. 100 successive referrals to the orthopaedic service as a result of roller/skate injuries were evaluated. Childs age, sex, time using apparatus, mechanism of injury, and whether the injury occurred in a dedicated skatepark or on the street was recorded. Whether the child was wearing any form of protective gear and what type was also recorded. The type of fracture and its treatment and follow up was evaluated. All results were recorded on standard excel spreadsheets and statistical analysis was performed using Instat statistics (Graphpad USA 2002). The Male to female ratio in street injuries was 1:1, whereas in ramp injuries 4:1. 60 injuries occurred on the street whereas 40 occurred whilst using the ramps. The mean age was 11.4yrs. The mean length of time using rollerblades/skateboards was 20 and 19 months for street and ramps respectively. The number of children wearing some form of protective gear shows only 20 children out of the 100 studied wore gear, of these 15 wore helmets only. The treatment initiated shows almost 80% of ramp related injuries required formal manipulation under general anaesthesia or open reduction and internal fixation, where as only 25% of street fractures required this form of treatment, The usage of ramps demonstrates an increased relative risk of 4.26 (95% CI 3.5–5.1) This study shows that skateboards and rollerblades still constitute a major component of childhood fracture admissions. Only 20% of children use some form of protective gear whilst skating, this needs to be addressed on a national level. The wearing of helmets whilst protecting the child against head injury do not prevent serious orthopaedic injuries. Wrist guards should be worn by all children skating as the fall onto outstretched hand still remains a childs defensive mechanism when thrown off balance. Almost 75% of all fractures involve the wrist or the forearm. We urge better education and a tighter supervision of children whilst skating. Dedicated skateparks should only be used by experienced and older children and they should at least be supervised during their first attempts at using the parks, 85% of ramp injuries occurred during first or second time users. A child using a skatepark particularily for the first time is three times more likely to sustain a fracture, and almost 4 and a half times more likely to require definitive surgical treatment of this fracture. This constitutes a huge orthopaedic burden as well as it’s associated morbidity and financial costs to the health service. Children should be encouraged to use limb protectors as well as helmets whilst skating and should be supervised more closely during their initial attempts

Introduction. The original Charnley-type negative pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty decades ago. Modern positive pressure surgical helmet systems (SHS) have not shown similar benefit, and several recent studies have shown a trend towards increased wound contamination and infection with SHS use. The gown glove interface may be one source of particle contamination. Objectives. The purpose of this study was to compare particle contamination at the gown glove interface in several modern SHS vs. a conventional gown. Methods. A 0.5 micron fluorescent powder was evenly applied to both hands to the level of the wrist flexion crease. After gowning in the normal fashion, the acting surgeon performed a standardized twenty minute simulated total joint replacement. The amount of gown contamination at the gown glove interface was then measured by three observers under ultraviolet light using a standardized grading scale; from 0 (no contamination) to 4 (gross contamination). Using Minitab 15, the Mann-Whitney U test was performed to compare gowns and an ordinal logistic regression analysis was performed to identify variables associated with levels of contamination. Results. All gown-glove interfaces showed some contamination. There was no difference among any of the gowns except for gown 2, which showed significantly more contamination when compared directly to each of the other four gowns (p<0.001 in each case) (Figure 1). The ordinal logistic regression analysis showed that gown type (p 0.10) was more significantly associated with contamination levels than were the other variables of observer (p 0.70), location of contamination (p 0.56), or trial order (p 0.5). Conclusions. Particle contamination occurs at the gown glove interface in most commonly used surgical helmet systems and was significantly increased in the gown with stiffer material that may be less apt to make a seal with the glove

Surfing is a popular UK water-sport. Recommendations for protective gear are based on studies abroad from trauma from large waves and reef breaks which may not be relevant in the UK. This study assesses the aetiology of UK surfing injuries in order to assist treatment and provide formative recommendations on protective equipment. Data was collected from UK surf clubs via an online survey. 130 individuals reported 335 injuries. M:F ratio 85:45, median age 28 (range 17–65). Head injuries were the most common (24%) followed by foot and ankle (19%). Surfers collided most often with their own boards (31%) followed by rocks/coral (15%), the sea (11%) and other surf boards (10%). Lacerations were the commonest injury (31%); followed by bruises/ black-eyes (24%) and joint/ligament sprains (15%). Concussions (5%), fractures (3%) and teeth injuries (1%) were rare. Less than 1/3 of all injuries required professional medical attention, 2 required operative intervention. Surfing injuries in the UK are common but usually minor. Serious head injuries (fractures and concussions) are rare. There is insufficient evidence to warrant the routine use of protective helmets whilst surfing in the UK, although protective head and foot gear may be considered when surfing the rarer reef/ rock breaks

Sledging related minor and major injuries represent a significant workload at ski-area medical centers across the world. Although safety rules exist, they are seldom obeyed or enforced. We set out to determine the incidence of sledging related injuries, identifying trends and causative factors at a busy New Zealand Ski resort. All sledging related injuries presenting during a 70-day period were prospectively reviewed. Patient demographics, mechanism, diagnosis, and treatment were recorded. Sixty patients were identified, mean age 10 years, range 4-30 years. Injuries comprised; collisions with sledgers (21), collision with wall (14) and falling from sledge (14). Site of injury included head (36), lower limb (18), spine (9), upper limb (7), and abdomen (2). Fractures included; femur (1), tibia (1), fibula (1), ankle (2), cuboid (1), clavicle (2), scaphoid (1). One 9-year-old patient sustained a serious intracranial haemorrhage, with subsequent permanent neurological sequelae. Sledging related injuries are mostly minor, however significant major injuries do occur requiring intervention at a secondary center. The potential for serious morbidity is evident. Recommendations supporting safety improvement measures does exist, however most were not implemented by the study cohort examined. The use of basic cycling helmets would seem an appropriate minimum level of protection, and greater sledging safety awareness should be encouraged

The amount of time spent in theatre by trainees is decreasing and therefore it seems crucial to fully optimis e these to enable adequate training. Trainees at the beginning of their practice, despite their exposure to surgery, cannot always take advantages of the surgical procedure they are assisting with. An obvious example of this is total hip replacement during posterior approach. Although the posterior approach and less invasive or minimally invasive approaches are certainly beneficial for patients, they are very difficult for a young trainee to comprehend, as they spend most of the time hanging onto the retractor without or rarely seeing the important anatomic steps of the procedure. Our goal was to develop a tool that would help a trainee to fully see and understand the surgical steps of total hip replacement during a posterior approach. To enable visualisation of the operation from the senior surgeon's perspective we developed a device to film the surgery and output the video feed to a screen. The prototype used an HD Replay XD1080 camera connected to a WDHI Xenta transmitting dongle (transmitting frequency −5.8 GHz), with an onboard 6600 mAh external Li-Mh battery providing 1A of current to the system. The Replay camera was fixed to the surgeon's ventilation helmet, and took its power from the battery supplying both the fan system and the transmitting unit. The surgeon can then clip both of these items to his belt and the connecting wires and cables run up his back. The device provided a Full HD video output of the surgery from the surgeon's perspective. The receiving unit used a Xenta WHDI wireless receiver with HDMI and DVI-I/D connections allowing the video to be displayed on any screen in the operating room with these connections. The prototype has been trialled by the senior author and was successful in allowing the direct surgeon's view of the procedure to be displayed on a screen in the theatre so that other staff involved in the operation could see it. Although the use of virtual training, presentations and video are essential to training, surgical training still relies greatly upon surgical assistance. The introduction of an intra-operative video feedback device would enable trainees to observe the operation from a first-person perspective which could lead to a considerable reduction in the amount of training time required, as well as a better understand of the specific surgical steps in a procedure. This would be particularly use for operations where a trainee assists the surgeon from the opposite side of the operating table, for example when undergoing total hip replacement during posterior approach. We can also envision this device also being used by surgeons to monitor their trainees when operating, and perhaps to keep a record of the operations undertaken in an establishment for archiving or assessment

Purpose: Multiple studies have described the general injuries associated with mountain biking. However, no detailed assessment of mountain biking associated spinal column fractures and spinal cord injuries (SCI) has previously been reported. The purpose of this study is to describe the patient demographics, injuries, mechanisms, treatments, outcomes and resource requirements associated with spine injuries sustained while mountain biking. Method: Patients who were injured while mountain biking, and presented to a provincial spine referral centre between 1995 and 2007 inclusive, with SCI and/ or spine fracture were included. A chart review was performed to obtain demographic data, and details of the injury, treatment, outcome and resource requirements. Results: 102 men and 5 women were identified for inclusion. The mean age at injury was 32.7 years 95%CI[30.6,35.0]. 79 patients (73.8%) sustained cervical injuries, while the remainder sustained thoracic or lumbar injuries. 43 patients (40.2%) sustained a SCI. Of those with cord injuries, 18(41.9%) were ASIA A, 5(11.6%) were ASIA B, 10(23.3%) ASIA C, and 10(23.3%) ASIA D. 67 patients (62.6%) required surgical treatment. The mean length of stay in an acute hospital bed was 16.9 days 95%CI[13.1,30.0]. 33 patients (30.8%) required ICU care, and 31 patients (29.0%) required inpatient rehabilitation. Of the 43 patients (39.6%) who presented with SCI, 14(32.5%) improved by one ASIA category, and 1 (2.0%) improved by two ASIA categories. Two patients remained ventilator-dependent at discharge. Conclusion: Spine fractures and SCI due to mountain biking accidents typically affect young, male, recreational riders. The medical, personal, and societal costs of these injuries are high. Injury prevention should remain a primary goal, and further research is necessary to explore the utility of educational programs, and the impact of helmets and other protective gear on spine injuries sustained while mountain biking

Dirt-bike and motocross riding are popular recreational activities in New Zealand. There are many competitive and recreational events organised for children within our catchment area every year. T he aims of this study were to document the pattern of paediatric motorbike injuries admitted at our level one trauma centre. Retrospective analysis of all patients under the age of 16 who were admitted to Waikato Hospital following a motorbike accident from January 2006 to May 2008. Patients were identifying using ICD 10 coding (U 651). Patient notes were retrieved and reviewed. Patients were excluded if they were not admitted from the emergency department. There were 70 admissions identified in 58 patients on ICD coding. Three admissions were excluded. Nine patients had two or more separate admissions during the study period. Fifty-seven were male and the average age was 12.5 (range 6 to 15). There were 21 admissions in 2006, 27 in 2007 and 19 in the first five months of 2008. 64 (96%) were admitted under the orthopaedic/trauma service. 87% were helmeted and 73% were wearing protective gear. Motocross riding was responsible for 60% of admissions. No patients died. One patient had documented loss of consciousness at the scene and the mean injury severity score was 5.8 (range 1 to 27). There were 108 documented injuries and 28% of patients had multiple injuries. Of all injuries, lower extremity (33%) and upper extremity (28%) and head injuries (12%) were most common. Three percent of patients required surgery with 24.4% of these requiring multiple anaesthetics. The average length of stay was three days (range 1 to 10). One patient was transferred to another centre for spinal surgery and rehabilitation. Severe motorbike injuries are common in Waikato. The number of severe injuries is increasing. Most injuries are associated with motocross and more than half require surgery. This increasing workload has financial implications on orthopaedic, trauma and emergency departments. Children riding motorbikes should wear helmets and protective gear at all times