Objectives. To assess the sensitivity and specificity of self-reported osteoporosis compared with dual energy X-ray absorptiometry (DXA) defined osteoporosis, and to describe medication use among participants with the condition. Methods. Data were obtained from a population-based longitudinal study and assessed for the prevalence of osteoporosis, falls, fractures and medication use. DXA scans were also undertaken. Results. Overall 3.8% (95% confidence interval (CI) 3.2 to 4.5) of respondents and 8.8% (95% CI 7.5 to 10.3) of those aged ≥ 50 years reported that they had been diagnosed with osteoporosis by a doctor. The sensitivity (those self-reporting osteoporosis and having low bone mineral density (BMD) on DXA) was low (22.7%), although the specificity was high (94.4%). Only 16.1% of those aged ≥ 50 years and with DXA-defined osteoporosis were taking bisphosphonates. Conclusions. The sensitivity of self-reporting to identify osteoporosis is low. Anti-osteoporotic medications are an important part of osteoporosis treatment but opportunities to use appropriate medications were missed and inappropriate medications were used

Introduction:. Wound healing and poor bone healing are complications seen in patients who smoke and some surgeons prefer not to operate on smokers. However, self reporting of smoking by patients may be biased. This study compares self-reporting of smoking habits and cotinine levels in the urine of our patients. Method:. 77 patients admitted for an osteotomy or arthrodesis procedure between September 2013 and May 2014 agreed to participate in this study. A questionnaire was completed and a urine sample was obtained and tested for cotinine, a metabolite of nicotine, by 2 techniques: a dipstick, the COT One Step Cotinine Test, yielding a positive result when the cotinine in the urine exceeds 200 ng/mL and the Concateno laboratory assay test, providing a mean value to give a qualitative reading whereby the cut off for non-smokers is 500ng/ml. Results:. Questionnaire results showed that 12 participants were active smokers, 35 classed themselves as ex-smokers and 30 were non-smokers. A dipstick result was negative in all the non-smokers, in 31/35 (89%) of the ex-smokers and in 4/12 (25%) of the current smokers. The dipstick test was positive in 4 self-reporting ex-smokers and only 8 of the 12 current smokers. The laboratory assay gave readings from 21 to 45,657 with higher readings being from heavier smokers. It correctly gave a value < 500 for all self-reporting non-smokers but 3 of the 35 self-reporting ex-smokers had a value between 500–5000ng/ml. Conclusion:. Whilst the majority of our patients had matching self-reporting smoking status and urine cotinine levels, 10% of self-reported ex-smokers had a high level of urine cotinine due to the test limitations or reporting bias by our patients. The £1.50 COT dipstick test is a cheap and easy way to correctly confirm a non-smoker compared to the Concateno laboratory assay which costs £7 excluding portering costs

Smoking is negatively implicated in healing and may increase the risk of surgical complications in orthopaedic patients. Carbon monoxide (CO) breath testing provides a rapid way of measuring recent smoking activity, but so far, to our knowledge, this has not been studied in elective orthopaedic patients. We studied whether CO-testing can be performed preoperatively in elective orthopaedic patients and whether testing accurately correlates with self-reported smoking status?. CO breath testing was performed on and a brief smoking history was obtained from 154 elective orthopaedic patients on the day of surgery. All patients admitted over 6 weeks for elective orthopaedic intervention were enrolled. 16.2% patients admitted to smoking. The mean CO levels were 15.2 ppm for self-reported smokers and 3.1 ppm for self-reporting non-smokers. One self-reporting non-smoker admitted to smoking after testing. 5 non-smoking patients had a CO breath of >=7, 1 had a CO level of >= 10 ppm. Using a cutoff of 7 ppm gave a sensitivity of 65.4% and a specificity of 96.1%, whilst a cutoff of 10 ppm gave a sensitivity of 57.6% and specificity of 99.2%. Whilst most patients are honest about smoking, CO testing can identify non-disclosing smokers undergoing elective orthopaedic procedures. Due to the high specificity, speed and cost-effectiveness, CO breath testing could be performed routinely to identify patients at risk from smoking-related complications in pre-assessment clinics. Smoking cessation services may reduce the risk of harm. CO testing on admission may demonstrate the efficacy of smoking cessation services

The December 2014 Foot & Ankle Roundup360 looks at: Charcot feet, biomarkers and diabetes; weight bearing following Achilles tendon rupture; endobuttons and mal-reduced diastasis; evidence for stem cell therapies in osteochondral lesions of the talus; syndesmosis fixation in SER ankle fractures; and self-reporting for foot and ankle outcomes

Introduction. With an ageing population comes an increased prevalence of osteoporosis and associated fracture. Whilst treatment of the condition following such a fracture is partially effective, primary prevention through screening and appropriate follow-up is the ideal. In order to assess a population's risk of fracture, paper questionnaires would traditionally have to be sent, however this is an wasteful and costly. A more efficient method may be to have patients assess their own FRAX score through a modified computer application. Aim. To investigate the feasibility of patients self-reporting their FRAX score from the use of a touch screen application. Methods. A patient-friendly application based on the FRAX questionnaire was developed for use on iPad. This was then trialled on inpatients and outpatients at the RNOH, Stanmore and at 2 GP's surgeries. A paper questionnaire then was used to assess ease of use of the application. Results. 314 patients completed the iPad application with 68 patients over 55 completing the paper questionnaire. The mean useability score was 2.6 (1-easy, 10-hard). 75% of respondents preferred using a touch screen application than paper or phone surveys and 83% stated they would use the touch screen if it was offered in GP surgeries. Discussion and Conclusion. Touch screen applications are readily used to self-report fracture risk by the majority of the over 55 population. Applications such as these have the potential to collect large amounts of data quickly and cheaply, as well as engaging patients in becoming aware of the risks of osteoporosis

Aims

To explore key stakeholder views around feasibility and acceptability of trials seeking to prevent post-traumatic osteoarthritis (PTOA) following knee injury, and provide guidance for next steps in PTOA trial design.

Aims

Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data.

Aims

No predictive model has been published to forecast operating time for total knee arthroplasty (TKA). The aims of this study were to design and validate a predictive model to estimate operating time for robotic-assisted TKA based on demographic data, and evaluate the added predictive power of CT scan-based predictors and their impact on the accuracy of the predictive model.

Aims

There is little published on the outcomes after restarting elective orthopaedic procedures following cessation of surgery due to the COVID-19 pandemic. During the pandemic, the reported perioperative mortality in patients who acquired SARS-CoV-2 infection while undergoing elective orthopaedic surgery was 18% to 20%. The aim of this study is to report the surgical outcomes, complications, and risk of developing COVID-19 in 2,316 consecutive patients who underwent elective orthopaedic surgery in the latter part of 2020 and comparing it to the same, pre-pandemic, period in 2019.

Aims

This study aims to define the epidemiology of trauma presenting to a single centre providing all orthopaedic trauma care for a population of ∼ 900,000 over the first 40 days of the COVID-19 pandemic compared to that presenting over the same period one year earlier. The secondary aim was to compare this with population mobility data obtained from Google.

Aims

This study sought to estimate the clinical outcomes and describe the nationwide variation in practice, as part of the feasibility workup for a National Institute for Health and Care Excellence (NICE) recommended randomized clinical trial to determine the optimal treatment of torus fractures of the distal radius in children.

The August 2014 Children’s orthopaedics Roundup³⁶⁰ looks at: Conservative treatment still OK in paediatric clavicular fractures; Femoral anteversion not the usual suspect in patellar inversion; Shoulder dislocation best treated with an operation; Perthes’ disease results in poorer quality of adult life; Physiotherapy little benefit in supracondylar fractures; Congenital vertical talus addressed at the midtarsal joint; Single-sitting DDH surgery worth the effort; and cubitus valgus associated with simple elbow dislocation

The October 2015 Research Roundup360 looks at: Wasted implants; Biofilms revisited; Peri-operative anticoagulation not required in atrial fibrillation; Determinants in outcome following orthopaedic surgery; Patient ‘activation’ and outcomes; Neuroplasticity and nerve repair; KOOS Score in predicting injury?

The October 2014 Children’s orthopaedics Roundup³⁶⁰ looks at: spondylolisthesis management strategies; not all cervical collars are even; quality of life with Legg-Calve-Perthe’s disease; femoral shaft fractures in children; percutaneous trigger thumb release – avoid at all costs in children; predicting repeat surgical intervention in acute osteomyelitis; and C-Arm position inconsequential in radiation exposure

The August 2013 Spine Roundup³⁶⁰ looks at: SPECT CT and facet joints; a difficult conversation: scoliosis and complications; time for a paradigm shift? complications under the microscope; minor trauma and cervical injury: a predictable phenomenon?; more costly all round: incentivising more complex operations?; minimally invasive surgery = minimal scarring; and symptomatic lumbar spine stenosis.

In 2006, approximately 1.3 million peer-reviewed scientific articles were published, aided by a large rise in the number of available scientific journals from 16 000 in 2001 to 23 750 by 2006. Is this evidence of an explosion in scientific knowledge or just the accumulation of wasteful publications and junk science? Data show that only 45% of the articles published in the 4500 top scientific journals are cited within the first five years of publication, a figure that is dropping steadily. Only 42% receive more than one citation. For better or for worse, “Publish or Perish” appears here to stay as the number of published papers becomes the basis for selection to academic positions, for tenure and promotions, a criterion for the awarding of grants and also the source of funding for salaries. The high pressure to publish has, however, ushered in an era where scientists are increasingly conducting and publishing data from research performed with ‘questionable research practices’ or even committing outright fraud. The few cases which are reported will in fact be the tip of an iceberg and the scientific community needs to be vigilant against this corruption of science.