Aims. Traumatic central cord syndrome (CCS) typically follows a hyperextension injury and results in a motor impairment affecting the upper limbs more than the lower limbs, with occasional sensory impairment and urinary retention seen. Current evidence on mortality and long-term outcomes is limited. The primary aim of this study is to assess the five-year mortality of CCS, and to determine any difference in mortality between management groups or age. Patients and Methods. Patients ≥18 years with traumatic CCS between January 2012 and December 2017 in Wales were identified. Patient demographics and injury, management and outcome data was collected. Statistical analysis was performed to assess mortality and between group differences. Results. 65 patients were identified (66.2% male, mean age 63.9 years). At five-years follow-up, 32.3% (n=21) of CCS patients were dead. 6 (9.2%) patients had died within 31 days of their injury. 69.2% (n=45) of patients were managed conservatively and there was no significant difference (p=0.062) in age between conservatively and surgically managed patients. Kaplan-Meier analysis revealed no significant difference in mortality between patients managed conservatively compared to those managed surgically (log rank test, p=0.819). However, there was a significant difference (p=0.001) in mortality between the different age groups (<50 years vs 50–70 years vs >70 years). At five-years follow up, 55.6% of the patient group aged >70 years at time of injury were dead. Respiratory failure was the most common cause of death (n=9, 42.9%). Conclusion. Almost one third of patients with traumatic CCS in Wales were dead at five years following their injury. Management type did not significantly affect mortality, however age at time of injury did. Further work assessing the long-term functional outcomes of surviving patients is needed, to allow more reliable prognostic information and functional recovery predictions to be given

The development of spinal deformity in children with underlying neurodisability can affect their ability to function and impact on their quality of life, as well as compromise provision of nursing care. Patients with neuromuscular spinal deformity are among the most challenging due to the number and complexity of medical comorbidities that increase the risk for severe intraoperative or postoperative complications. A multidisciplinary approach is mandatory at every stage to ensure that all nonoperative measures have been applied, and that the treatment goals have been clearly defined and agreed with the family. This will involve input from multiple specialities, including allied healthcare professionals, such as physiotherapists and wheelchair services. Surgery should be considered when there is significant impact on the patients’ quality of life, which is usually due to poor sitting balance, back or costo-pelvic pain, respiratory complications, or problems with self-care and feeding. Meticulous preoperative assessment is required, along with careful consideration of the nature of the deformity and the problems that it is causing. Surgery can achieve good curve correction and results in high levels of satisfaction from the patients and their caregivers. Modern modular posterior instrumentation systems allow an effective deformity correction. However, the risks of surgery remain high, and involvement of the family at all stages of decision-making is required in order to balance the risks and anticipated gains of the procedure, and to select those patients who can mostly benefit from spinal correction.

Background and Purpose of Study:. Differences in regional lumbar angles in sitting have been observed between subgroups of NSCLBP patients exhibiting motor control impairments (MCI) (O'Sullivan, 2005; Dankaerts et al, 2006). However, differences in standing posture and other spinal regions are unknown. This study aimed to compare regional spinal angles in healthy and MCI subgroups in sitting and standing. Methods:. An observational, cross-sectional study investigated spinal kinematics of 28 Flexion Pattern (FP), 23 Active Extension Pattern (AEP) (O'Sullivan, 2005) and 28 healthy controls using 3D motion analysis (Vicon) during usual sitting and standing. Mean sagittal angle for Total Lumbar (TotLx), Total Thoracic (TotTx), Upper Thoracic (UTx), Lower Thoracic (LTx), Upper Lumbar (ULx) and Lower Lumbar (LLx) regions between groups were compared using one-way ANOVA. Results:. No differences in total thoracic and lumbar regions were observed, except TotLx in sitting between FP and AEP (Mean Difference (MD)=15.81°, p=0.003). Significant differences were observed in ULx and LTx for standing and sitting between FP and AEP (ULx Standing MD=9.89°, p=0.003; ULx Sitting MD=12.32°, p=0.000; LTx Standing MD=7.57°, p=0.05; LTx Sitting MD=11.72°, p=0.001) with AEP demonstrating greater extension in these regions. FP exhibited greater flexion compared to controls in ULx and LTx, except LTx in standing (ULx Standing MD=7.69°, p=0.018; ULx Sitting MD=6.96°, p=0.014; LTx Sitting MD=11.28°, p=0.001). No differences between AEP and controls were observed in sitting or standing. Conclusion:. Observing subdivided regional spinal angles is key to identifying MCI sub-group differences, with ULx and LTx able to discriminate between FP and AEP, and FP and healthy controls. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting. Conflicts of interest: No conflicts of interest. Sources of funding: Arthritis Research UK / Presidents Research Scholarship, Cardiff University

The imminent introduction of the new Trauma & Orthopaedic (T&O) curriculum, and the implementation of the Improving Surgical Training initiative, reflect yet another paradigm shift in the recent history of trauma and orthopaedic training. The move to outcome-based training without time constraints is a radical departure from the traditional time-based structure and represents an exciting new training frontier. This paper summarizes the history of T&O training reform, explains the rationale for change, and reflects on lessons learnt from the past.

Cite this article: Bone Jt Open 2021;2-3:181–190.

In a society dependent upon the motor car, impaired driving ability is a significant disability which may affect patients with total knee replacement during the postoperative rehabilitation. Recently, there has been much interest in minimally invasive surgery for total knee arthroplasty (TKA). This study evaluated the hypothesis that a minimally invasive technique using a small incision (7 to 10 cm), and a minimal quadriceps muscle splitting without eversion of the patella (MIS approach) would have a beneficial effect on driving reaction time. 15 patients undergoing a primary TKA with the MIS approach were compared with 15 TKAs using a standard approach. An experimental car was used to measure the force and timing of pressure by the foot on accelerator and break pedals. The mean reaction time for normal adults was 0.442 s to go from the accelerator to the brake pedal. This time falls well within the code guideline of 0.7 s. The driving reaction times of the patients with knee arthroplasty were measured at one, two and three months after the operation. The ability to perform an emergency stop was assessed as the time taken to achieve a brake pressure of 100 N after a visual stimulus.The patients have an actual follow-up of 2 years. A clinical and radiological evaluation was performed. Radiographic analysis included evaluation of postoperative alignment variables and progressive radioluciencies. Over all 27 among the 30 knees have good and excellent objective knee Society Scores and patient satisfaction indices. The patients in the MIS group had a statistically shorter time until they could straight leg raise, used less epidural analgesia, used less overall analgesics and had a more rapid regaining of flexion. Patients with standard approach and technique for total knee replacement recovered sufficient knee function to return to driving at only three months after the operation according to the time and the force necessary to the brake pedal. Patients with mini invasive surgery approach have recovered sufficient knee function to return driving at one month after the operation. There was no significant difference in alignment of implants and in alignment of the knee between the two groups. Three knees had radioluciencies (two with a standard incision and one with a MIS approach). Using a small incision without patellar eversion does not jeopardize the alignment of the implants and improves postoperative rehabilitation