In a retrospective review, 38 consecutive Workers’ Compensation (WC) patients undergoing primary total knee arthroplasty (TKA) were matched to a cohort of non-WC patients for demographics and preoperative diagnosis. Outcome measures included the Knee Society Score (KSS), the Oxford Knee Score, the McGrory Modified Knee Score (MMKS), patient satisfaction and number of postoperative clinic visits. Unpaired t-tests were used to determine differences in outcomes. Pre-operative KSS, pain and flexion range as measured by KSS, and Oxford scores displayed no statistical differences. The differences in the two groups at six weeks was significant in respect of KSS (p =0.0005) pain as measured by KSS (p =0.015), and flexion range (p =0.012). At six months similar results were noted in pain as measured by KSS (p =0.018), Oxford scores (p =0.005) and flexion range (p =0.035), but KSS function was not significant (p =0.073). One-year Oxford scores (p =0.013) and flexion range (p =0.013) were statistically significant, as were MMKS (p =0.001), patient expectations (p =0.030), perceived quality of life (p =0.009), and number of postoperative clinic visits (p =0.003). The short-term outcomes of primary TKA in patients receiving workers’ compensation benefits are inferior to those obtained by non-workers’ compensation patients. Workers’ compensation patients are seen more often for postoperative follow-up, which we would attribute to the persistence of subjective complaints following primary TKA

Introduction There is a perception in the orthopaedic community that patients with workers’ compensation claims have a poorer outcome than non-compensation patients. This review aims to identify and quantify the effect of workers’ compensation claims on the outcome of orthopaedic treatment.

Methods A systematic review of the literature was performed. Studies of any language published between 1966 and 2002 that compared the outcomes of compensation against a non-compensation group for any orthopaedic treatment were included. Articles with any group less than 20 patients were excluded. Literature searching and data extraction were performed independently by both reviewers and then compared. Differences between reviewers’ findings were resolved by discussion. Measures of region specific objective outcome, where available, were pooled into satisfactory and unsatisfactory groups for comparison. The raw data was used for a meta-analysis. The total number of articles that met the search criteria was 63. Within these articles there were 7,279 patients with workers’ compensation claim and 14,368 patients with no compensation claim.

Results No articles found that the workers’ compensation group had better outcomes. Fourteen found no difference between the two groups while 49 articles described a worse outcome in the compensation group. In the 41 papers which had outcome scores available for comparison there were 3,608 compensation patients with outcome scores and the outcome was unsatisfactory in 33.7%. There were 6,607 non-compensation patients with outcome scores and the outcome was unsatisfactory in 15.1% of non-compensation patients. The difference was significant (p< 0.01). The Relative Risk (RR) of an unsatisfactory outcome in workers’ compensation patients is 2.2. The Attributable Risk (AR), which gives the percentage of poor outcomes in the compensation group directly attributable to their compensation status, was 55.1%. Subgroup analysis of the major groups (spine: n=7,815, carpal tunnel: n=743, and shoulder n=379) revealed similar findings for each group (spine: RR=2.1, carpal tunnel: RR=2.2, shoulder: RR=5.1).

Conclusions From reviewing the literature, workers’ compensation patients have a poorer outcome compared to non-compensation patients for the same orthopaedic conditions. A workers’ compensation patient has more than double the risk of having a poor outcome in comparison to the non-compensation patient. More than half of the poor results in the compensation group can be attributed to their compensation status.

Introduction. Individuals with significant hip and knee trauma receive total knee (TKA) and total hip arthroplasty (THA) as definitive end-stage procedures. In Aotearoa, injury-related costs, including workers compensation, may be funded by ACC. With a steady increase of arthroplasty procedures in Aotearoa, we aim to understand the magnitude and characteristics of such procedures to inform future healthcare strategies. Method. This is a longitudinal collaborative study from 1st January 2000 to 31st December 2020, using ACC and New Zealand Joint Registry databases. Total cost was subcategorised into social and medical cost for analysis. Results. ACC funded 10179 TKA and 5611 THA, amounting to 918 million New Zealand Dollars. Most clients were between 55 and 65 years of age at time of surgery, with greater representation by Male sex and European prioritised ethnicity. Māori and Pacific peoples represent less than 10% of the study population. ACC identified requiring more than 182 days of workers’ compensation as a significant marker for needing additional supports. Risk of this was 21% for TKA and 11% for THA, with risk factors being younger age (RR 0.96), Male sex (TKA RR 1.12, THA RR 1.23), and heavy work-types (TKA RR 1.50, THA RR 1.57). Discussion. Supporting individuals with post-traumatic lower limb arthroplasty is costly. Workers’ compensation contributes to a significant proportion of social expenditure. Risk factors for increased cost utilisation can be used to highlight vulnerable clients and target interventions. Conclusions. This is one of few nationwide studies investigating the healthcare cost of post-traumatic lower limb arthroplasty. We need to focus on injury prevention, targeted treatment, and rehabilitation protocols to improve recovery and reduce time off work. These findings would be of interest to multiple stakeholders

Purpose: Persistent radiculopathy secondary to lumbar disc herniation is a common problem that greatly compromises quality of life. In North America, lumbar discectomies are among the most common elective surgical procedures performed. There is still much debate about when conservative or surgical treatments should be offered to patients. Although the related literature is comprehensive, there are limited systematic reviews on the prognostic factors predicting the outcome of lumbar discectomy. The purpose of this review is to define the preoperative factors predicting clinical outcome after lumbar discectomy. Method: We conducted a computerized literature search using Ovid Medline and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials or prospective studies dealing with lumbar disc surgery. The preoperative predictors had to be clearly identified and correlated with outcome measures in terms of pain, disability, work capacity, analgesia consumption, or a combination of these measures. We assessed the articles as high or low quality studies using the Newcastle-Ottawa Quality Assessment Scale, and summarized the results of High Quality Studies. Results: A total of 39 articles were included. The two most prominent negative predictors were Workers’ Compensation status and depression according to 6 studies. Poor predictors reported in 4 articles were female gender, increasing age, and prolonged duration of leg or back pain. Lower education level, smoking, and higher levels of psychological complaints were negative predictors in 3 articles. A positive Lasègue sign was a positive predictor in 7 articles. Absence of back pain, positive patient expectations, and higher income were good prognostic factors in 3 studies. Patients with contained herniations did worse than those who had uncontained disc extrusions and sequestrations according to 4 studies. The level of herniation was not a predictive factor in 7 studies. Conclusion: Workers’ Compensation, depression, greater back versus leg pain, increasing age, female gender, contained herniations, and prolonged symptoms predict unfavourable postoperative outcomes after lumbar discectomy. Positive Lasègue sign, higher income, uncontained herniations, and positive patient expectations predict favourable postoperative outcomes. The level of herniation is not an established prognostic factor. The results of this review provide a preliminary framework for patient selection for lumbar disc surgery

Purposes and Background. Musculoskeletal disorders including as back and neck pain are leading causes of work disability. Effective interventions exist (i.e. functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool developed using machine learning to help select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample. Our purpose was to externally validate the WATT. Methods and Results. A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial compensation database. Data were available on workers being considered for rehabilitation between January 2013 and December 2016. Data was obtained on patient characteristics (ie. age, sex, education level), clinical factors (ie. diagnosis, part of body affected, pain and disability ratings), occupational factors (ie. occupation, employment status, modified work availability), type of rehabilitation program undertaken, and return-to-work outcomes (receipt of wage replacement benefits 30 days after assessment). Analysis included classification accuracy statistics of WATT recommendations for selecting interventions that lead to successful RTW outcomes. The sample included 5296 workers of which 33% had spinal conditions. Sensitivity of the WATT was 0.35 while specificity was 0.83. Overall accuracy was 73%. Conclusion. Accuracy of the WATT for selecting successful rehabilitation programs was modest. Algorithm revision and further validation is needed. No conflicts of interest. Sources of funding: Funding was provided by the Workers' Compensation Board of Alberta

Compared to single-incision distal biceps repair (SI), double-incision repair (DI) theoretically allows for reattachment of the tendon to a more anatomically favorable position. We hypothesized that DI repair would result in greater terminal supination torque compared to SI repair for acute distal biceps ruptures. In this retrospective cohort study, patients were included if they sustained an isolated, acute (° supinated position. Secondary outcomes included supination torque in 45° supinated, neutral, and 45° pronated positions, ASES elbow score, DASH, SF-12, and VAS. Power analysis revealed that at least 32 patients were needed to detect a minimum 15% difference in the primary outcome (β = 0.20). Statistical analysis was performed with significance level α = 0.05 using R version 3.4.1 (R Core Team 2017, Vienna, Austria). Of 53 eligible patients, 37 consented to participate. Fifteen were repaired using DI technique and 22 using SI technique. Mean age was 47.3yrs and median follow-up time was 28.1months. The groups did not differ with respect to age, time-to-follow-up, dominance of arm affected, Workers Compensation or smoking status. Mean supination torque, measured as the percentage of the unaffected side, was 60.9% (95%CI 45.1–76.7) for DI repair versus 80.4% (95%CI 69.1–91.7) for SI repair at the 60°supinated position (p=0.036). There were no statistically significant differences in mean supination torque at the 45°supinated position: 67.1% (95%CI 49.4–84.7) for DI versus 81.8% (95%CI 72.2–91.4) for SI (p=0.102), at the neutral position: 88.8% (95%CI 75.2–102.4) for DI versus 97.6% (95%CI 91.6–103.7) for SI (p=0.0.170), and at the 45°pronated position: 104.5% (95%CI 91.1–117.9) for DI versus 103.4 (95%CI 97.2–109.6) for SI (p=0.0.862). No statistically significant differences were detected in the secondary outcomes ASES Pain, ASES Function, DASH scores, SF-12 PCS or MCS, or VAS Pain. A small difference was detected in VAS Function (median 1.3 for DI repair versus 0.5 for SI repair, p=0.023). In a multivariate linear regression model controlling for arm dominance, age, and follow-up time, SI repair was associated with a greater mean supination torque than DI repair by 19.6% at the 60°supinated position (p=0.011). Contrary to our hypothesis, we found approximately a 20% mean improvement in terminal supination torque for acute distal biceps ruptures repaired with the single-incision technique compared to the double-incision technique. Patients uniformly did well with either technique, though we contend that this finding may have clinical significance for the more discerning, high-demand patient

Compared to single-incision distal biceps repair (SI), double-incision repair (DI) theoretically allows for reattachment of the tendon to a more anatomically favorable position. We hypothesized that DI repair would result in greater terminal supination torque compared to SI repair for acute distal biceps ruptures. In this retrospective cohort study, patients were included if they sustained an isolated, acute (° supinated position. Secondary outcomes included supination torque in 45° supinated, neutral, and 45° pronated positions, ASES elbow score, DASH, SF-12, and VAS. Power analysis revealed that at least 32 patients were needed to detect a minimum 15% difference in the primary outcome (β = 0.20). Statistical analysis was performed with significance level α = 0.05 using R version 3.4.1 (R Core Team 2017, Vienna, Austria). Of 53 eligible patients, 37 consented to participate. Fifteen were repaired using DI technique and 22 using SI technique. Mean age was 47.3yrs and median follow-up time was 28.1months. The groups did not differ with respect to age, time-to-follow-up, dominance of arm affected, Workers Compensation or smoking status. Mean supination torque, measured as the percentage of the unaffected side, was 60.9% (95%CI 45.1–76.7) for DI repair versus 80.4% (95%CI 69.1–91.7) for SI repair at the 60°supinated position (p=0.036). There were no statistically significant differences in mean supination torque at the 45°supinated position: 67.1% (95%CI 49.4–84.7) for DI versus 81.8% (95%CI 72.2–91.4) for SI (p=0.102), at the neutral position: 88.8% (95%CI 75.2–102.4) for DI versus 97.6% (95%CI 91.6–103.7) for SI (p=0.0.170), and at the 45°pronated position: 104.5% (95%CI 91.1–117.9) for DI versus 103.4 (95%CI 97.2–109.6) for SI (p=0.0.862). No statistically significant differences were detected in the secondary outcomes ASES Pain, ASES Function, DASH scores, SF-12 PCS or MCS, or VAS Pain. A small difference was detected in VAS Function (median 1.3 for DI repair versus 0.5 for SI repair, p=0.023). In a multivariate linear regression model controlling for arm dominance, age, and follow-up time, SI repair was associated with a greater mean supination torque than DI repair by 19.6% at the 60°supinated position (p=0.011). Contrary to our hypothesis, we found approximately a 20% mean improvement in terminal supination torque for acute distal biceps ruptures repaired with the single-incision technique compared to the double-incision technique. Patients uniformly did well with either technique, though we contend that this finding may have clinical significance for the more discerning, high-demand patient

Introduction: The optimal treatment of intra-articular calcaneal fractures remains controversial. Material and Methods: Electronic databases were searched for randomised trials comparing interventions for treating patients with calcaneal fractures. Two reviewers independently assessed trial quality, using a 12-item scale, and extracted data. Where appropriate results were pooled. Results: Six trials met the inclusion criteria. Two reports reported on the same group of patients at differing follow-up intervals. All six included trials had methodological flaws. Another two trials are ongoing. Four trials (134 patients) compared open reduction and internal fixation (ORIF) with non-operative management. Pooled results showed no difference in residual pain (24/40 versus 24/42; OR 0.90, 95% CI 0.34 to 2.36), but a lower proportion of the operative group was unable to return to the same work (11/45 vs 23/45; OR 0.30, 95% CI 0.13 to 0.71), and was unable to wear the same shoes as before (12/52 vs 24/54; OR 0.37, 95% CI 0.17 to 0.84). One large-scale study showed that the outcomes (SF-36, visual analogue scale (VAS), Bohler’s angle) after non-operative treatment were not different to those after ORIF. ORIF gave superior results for return to work, return to normal activities and ability to wear the same shoes. The subtalar fusion rate was reduced after ORIF. Excluding patients receiving Workers’ Compensation, the outcomes were significantly better in some groups of surgically treated patients. One trial (23 patients), evaluated impulse compression therapy. At one year there was a mean difference of 1.40 pain VAS units (95% CI 0.02 to 2.82) in favour of the treated group. The impulse compression group had greater subtalar movement at three months, and patients returned to work three months earlier. Conclusions: The relatively poor quality of existing trials means that current evidence is only tentative. It remains unclear whether the possible advantages of surgery are worth its risks

Introduction and Aims: Several surgical techniques have been described for the treatment of resistant lateral epicondylitis or tennis elbow with variable results. This retrospective study presents the long-term outcome of a single surgeon’s experience, with a modified surgical technique for the treatment of resistant lateral epicondylitis. Method: Between 1986 and 2001, the senior author performed 171 surgical procedures in 158 patients for resistant lateral epicondylitis. 147 elbows in 136 patients (88%) were independently evaluated at a mean time to follow-up of 9.8 years. Patients were assessed using a functional questionnaire and physical assessment. In addition to physical assessment, provocative testing of the extensor origin and grip strength was performed. Patients subjectively rated the result of surgery and these results were compared to objective elbow performance scores. Results: Subjectively, 97% of patients assessed the result from surgery as good to excellent. Objectively, 97% results were good to excellent using elbow performance scores. Synovial fistulae developed in two patients by day 10 post-operatively. One patient required further surgery for a synovial fistula, which healed with no sequelae. There were no other complications following surgery. The post-operative range of motion improved in all patients, but remained reduced in four patients. There was a significantly worse outcome for patients with a Workers’ compensation claim and for cigarette smokers. There was no difference between grip strengths between the operated arm and the non-operated arm. The majority of patients returned to work by six weeks and were pain-free by 12 weeks. Less than 5% of patients experienced lateral epicondylitis pain in their elbow post-operatively. A small group of patients altered their occupation or recreational activities due to tennis elbow symptoms. Conclusion: The surgical technique described produces excellent results in greater than 87% of patients in the treatment of resistant lateral epicondylitis. This procedure produces a low complication rate and is associated with a high rate of patient satisfaction. Patient selection is critical in the surgical treatment of resistant lateral epicondylitis

Testing of cadaver ankle specimens was conducted to investigate the changes in kinematics with lateral ligament reconstructions. Testing included an intact condition, after injury at the ATFL and CFL sites, and separately a Brostrom repair and an anatomical gracil-lis graft reconstruction. Calcaneal range of motion was determined about the axis of applied moment in plantarflexion-dorsiflexion and in inversion-eversion directions. The injury and reconstructions were most sensitive during IE applied moment. Both reconstructions appeared to behave similar to intact motion. Failure of some Brostrom repairs however, suggest that the gracillis-graft reconstruction is initially a stronger repair. Limited research has biomechanically investigated lateral ankle ligament reconstruction procedures. The objective of this study was to determine the changes in ankle kinematics with a dual ligament Brostrom repair and an anatomical gracillis graft reconstruction. Seven cadaveric ankle specimens were tested independently in an intact condition, after an ATFL/CFL injury model, and two reconstructions. The anatomical graft reconstruction wove a gracillis tendon through the calcaneus and fibula to dually reconstruct the ATFL and CFL, and anchored to the talus. Moments were applied to the calcaneus for three cycles in plantarflexion-dorsiflexion (PD) and inversion-eversion (IE) while allowing unconstrained motion. Three dimensional motions of the calcaneus and tibia were optoelectronically tracked. Range of motion (ROM) was calculated about the axis of applied moment for the calcaneus with respect to the tibia. The ROM increase from the intact condition with the injury model was only significant for IE (p=0.001). No significant differences were found between intact and any treatments in the PD configuration. In IE, both the graft reconstruction and the Brostrom repair were significantly different from the injury model (p=0.002 and p=0.015 respectively), where the gracillis reconstruction appears more similar to the intact condition. For two specimens the Brostrom repaired ATFL failed during applied inversion moment. The injury and reconstructions were most sensitive during IE applied moment. Both reconstructions appeared to behave similar to the intact condition. Failure of some Brostrom repairs however, suggest that the gracillis-graft reconstruction is initially a stronger repair. Funding: Workers Compensation Board of British Columbia

Repair of large rotator cuff tears can be a demanding technical exercise, particularly when patients are elderly and tissue quality for repair is poor. In 25 patients we have used a method of tying rotator cuff sutures over a screw fixation post at the level of the surgical neck to secure the torn cuff to the greater tuberosity while healing occured. This study reports the results of these patients. 25 patients (27 shoulders) of average age 68.5 years were reviewed at an average of 22 months post surgery (range 3– 52 months). 4 patients (6 shoulders) were workers compensation injuries. The Constant method of shoulder assessment and visual analogue pain scores were used. Constant scores improved from an average of 30.6 pre-operatively to 75.2 post operatively. Pain scores improved from an average of 7.2 pre-operatively to 2.2 post operatively. Over 80 % of patients reported being very satisfied with the results of their procedure. 2 patients reported being unsatisfied with their procedure. Workers compensation patients had poorer results for pain and function than the group average but still reported good satisfaction with the procedure. 4 complications occurred. 2 patients had re- tears of their cuff after falls. One was repaired with side to side suturing and the other was re-repaired to the post. 1 wound infection occurred requiring arthroscopic shoulder lavage and final removal of the implant. This shoulder subsequently healed with good function. One patient had significant shoulder pain requiring surgery and removal of the fixation post. There were no other cases of screw irritation and no axillary nerve palsy or deltoid avulsions were found. Conclusions: This method of fixation is simple, strong, safe and gives results at least equivalent to if not better than other reported methods. The technique is a useful one to have in the surgical repertoire when dealing with large rotator cuff tears in older patients

The relations among tissue quality, socket discomfort, gait characteristics, and socket pressures are not well established for the unilateral below-knee amputee population. These relations were evaluated for six amputees at seventeen regions of interest on the residual limb. Pressure sensors were placed directly on the residual limb. Peak dynamic socket pressures were not directly related to peak joint moments. However, increases in ground reaction forces (GRFs) related to increases in socket pressures. The relations among tissue quality, socket discomfort, gait characteristics, and socket pressures are not well established for the unilateral below-knee amputee population. The purpose of this study was to evaluate these relations for six amputees. A thorough understanding of pressure distribution between the residual limb and prosthetic socket is critical to socket design and limb health. The subjects ranged in age from thirty to seventy-two years of age. The inclusion criteria were male, unilateral transtibial amputation, ability to ambulate independently, non-diabetic, no debilitating health conditions, non-recent amputee. Tissue sensation and socket discomfort were evaluated at seventeen regions of interest on the residual limb. Tissue sensation was assessed using Semmes-Weinstein monofilaments to test light touch/deep pressure sensation, tuning fork to test vibration sensation, and pinprick to test pain sensation. Socket discomfort was assessed using 10 cm Visual Analogue Scale. Gait characteristics were recorded during walking using a Motion Analysis System. Socket pressure measurements were made using F-socket pressure sensors in conjunction with I-Scan software program. Pressure sensors were placed directly on residual limb. Gait characteristics and socket pressures were compared across three different testing days. The site-specific tissue sensitivity scores did not correlate with the socket discomfort scores. In addition, site-specific discomfort scores did not correlate with peak socket pressures recorded at subject’s normal walking speed. Significant day-to-day pressure differences were found at four of the seventeen areas of interest. Peak dynamic socket pressures were not directly related to peak joint moments. Two subjects demonstrated direct relations between ground reaction forces (GRFs) and socket pressure on the different test days. Funding: NSERC, Workers’ Compensation Board (Alberta), University of Calgary

Introduction and aims: Good outcome for rotator cuff repair has been reported for open, arthroscopically assisted miniopen and arthroscopic techniques. Patient outcomes are affected by tear characteristics, patient factors and surgical experience. Little information is reported in literature on the affect on outcome in the presence of delamination tearing found at surgery. This prospective study compares outcome of miniopen rotator cuff repairs with and without delamination. Method: A prospective analysis between November 2004 and January 2008 allowed data collection on arthroscopically assisted miniopen rotator cuff repairs performed by a single surgeon using the same technique. The Western Ontario Rotator Cuff score (WORC) was used as the measurement tool to assess outcome. Scores were recorded pre-operatively and at 6 months, 12 months and 2 years post-operatively. Results: 229 arthroscopically assisted miniopen rotator cuff repairs were performed on 221 patients. Tear size and presence of delamination were recorded at the time of surgery. Incidence of delamination was 72%. The average age of patients was 58.6 years. There was no age difference in the incidence of delamination. Incidence of delamination was 72% in patients under 60 years (n=123) and 71% in patients over 60 years (106). 72% (of 62) female shoulders showed delamination and 71.5% (of 168) male shoulders showed delamination. Tears of less than 3cm had a 64% incidence of delamination. Tears greater than 3cm had 76% incidence of delamination. No difference in pre-operative WORC scores between delaminated group versus non-laminated group. Pre-operative WORC scores showed both delaminated and non-laminated tears had 40% of maximum score. Analysis at 2 years showed no difference in outcome of non-laminated tears (84% of maximum score) compared with delaminated tears (84% of maximum score). Size at time of repair did not affect outcome. Outcome showed slightly better results for delaminated tears in the older age group. Workers compensation patients achieved poorer outcomes than non workers compensation patients but there was no difference for delaminated versus non-laminated tears. Conclusions: Prospective analysis of outcome on arthroscopic assisted minideltoid rotator cuff repairs demonstrates that both non-laminated and delaminated rotator cuff tears achieve excellent outcomes at 2 years. There is no significant difference in outcome of repair when comparing workers compensation, size of tear or sex. Increasing age was a positive predictor for outcome at 6 and 12 months. It remains to be seen whether arthroscopic techniques can achieve similar results

Introduction Minimally invasive lumbar discectomy using the METRx™ System (MAST discectomy) has been advocated as an alternative to open microdiscectomy for symptomatic posterolateral lumbar disc herniation. This paper presents a quality assurance dual surgeon retrospective study with independent observer minimum twelve month follow-up. Methods This study was approved by the Ethics Committee of the Princess Alexandra Hospital prior to commencement. All patients who underwent MAST discectomy using the METRx™ System for the management of radiculopathy caused by posterolateral lumbar disc herniation under the care of two surgeons (AN and RK) more than twelve months prior to the commencement of assessment were included in the study. The patient demographic data was collected contemporaneously, operation performance data was collected retrospectively from hospital databases and outcome data was collected by telephone interview by independent observers (PL, SO and JP) a minimum of twelve months after discharge from hospital. Results 101 patients (53 males, 48 females) (average age 43 years, range 17 to 83 years) underwent 102 procedures between July 2001 and December 2004. Surgery was performed on the right side in 63 cases and was either at L4/5 (30%) or more commonly L5/S1 (70%). 21 were public patients and 80 private patients with 59 episodes of surgery occurring in a public hospital. 46 operations were performed with the METRx™ MED System and 56 with the METRx™ MD System. The average duration of surgery for patients at the Princess Alexandra Hospital (n = 48) was 88 minutes with an average length of post-operative hospital stay of 22 hrs 35 mins. 16 of these cases were performed as day surgery. Perioperative complications were: conversion to open (3), urine retention (7), nausea and vomiting (3), durotomy (5), wound haematoma not requiring surgery (1) and incorrect level surgery identified and rectified during surgery (1). The average length of time from surgery to independent follow-up was 679 days (range: 382 to 1055) with 78% successful contact. On the Modified McNabb Outcome Scale, 83% reported an excellent or good outcome, 9% reported a fair outcome and 8% a poor outcome. The time until return to work was identified as less than two weeks in 28% and between 2 weeks and 3 months in 39%. Patients whose surgery was funded by Workers Compensation were over-represented in both the poor outcomes and delayed return to work. 4 patients reported progressive severe low back pain, 10 patients reported ongoing lower limb pain (severe in 1 and mild in 9) and 1 patient underwent surgery for a recurrent disc prolapse. Further disc prolapse at different sites was identified in five patients. Discussion The retrospective data in this study forms class IV evidence for efficacy. As a quality assurance exercise it suggests an acceptable level of safety and efficacy to allow further technique development and study. A prospective randomized controlled study is proposed. The high incidence of urine retention early in the series of one surgeon is considered to be related to the practice of placing depot morphine in the operative bed. The reduction in complications in general and the improvement in duration of surgery over the series is evidence of the learning curve for this procedure

Aims

The aim of this study was to create artificial intelligence (AI) software with the purpose of providing a second opinion to physicians to support distal radius fracture (DRF) detection, and to compare the accuracy of fracture detection of physicians with and without software support.

Aims

Patient-reported outcome measures have become an important part of routine care. The aim of this study was to determine if Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be used to create patient subgroups for individuals seeking orthopaedic care.

Aims

Brachial plexus injury (BPI) is an often devastating injury that affects patients physically and emotionally. The vast majority of the published literature is based on surgeon-graded assessment of motor outcomes, but the patient experience after BPI is not well understood. Our aim was to better understand overall life satisfaction after BPI, with the goal of identifying areas that can be addressed in future delivery of care.