Orthopaedics has been left behind in the worldwide drive towards diversity and inclusion. In the UK, only 7% of orthopaedic consultants are female. There is growing evidence that diversity increases innovation as well as patient outcomes. This paper has reviewed the literature to identify some of the common issues affecting female surgeons in orthopaedics, and ways in which we can address them: there is a wealth of evidence documenting the differences in the journey of men and women towards a consultant role. We also look at lessons learned from research in the business sector and the military. The ‘Hidden Curriculum’ is out of date and needs to enter the 21st century: microaggressions in the workplace must be challenged; we need to consider more flexible training options and support trainees who wish to become pregnant; mentors, both male and female, are imperative to provide support for trainees. The world has changed, and we need to consider how we can improve diversity to stay relevant and effective.

Cite this article: Bone Jt Open 2021;2-10:893–899.

Hypermobility Spectrum Disorder (HSD or hEDS) is attributed to a collagen abnormality associated with excessive joint flexibility. Approximately 90% of females with hip dysplasia have hypermobility. Manifestations of hypermobility in various body systems are unique to every patient, affecting different tissues of the body with varying degrees of severity. Our purposes were to identify the manifestations of hypermobility across multiple body systems and to study the recognition of hypermobility in the medical literature of multiple specialties over multiple decades. A literature search of the major medical disciplines for key words associated with HSD was performed. These specialties included gastroenterology, gynecology, neurology, psychiatry, oral-maxillofacial surgery, cardiology, and orthopaedic surgery. A specialty-specific impact factor (IF) score was calculated as the percentage of research articles that referenced hypermobility as a comorbidity over all articles within that specialty. Statistical differences were identified using single factor ANOVA with significance determined at p<0.05. We reviewed many published, specialty-specific manifestations of hypermobility, and describe them. All six non-orthopaedic specialties demonstrated a continually increasing relative IF ratio throughout the study period with a peak impact average of 0.22 (p<0.05 compared with other time ranges). There was a 93.3% overall increase in IF scores from the 1992–1998 period to the most recent period examined (p<0.05). Hypermobility is increasingly recognized as a significant health issue in multiple disciplines. Since dysplasia is associated with approximately 40% of all primary total hip arthroplasty cases, understanding the multi-system manifestations, and broad impact of hypermobility on patients, is relevant for every hip surgeon. We are expanding our research into other medical disciplines, including urology, ophthalmology, dermatology, clinical psychology, and others

Introduction. Horizontal gaze palsy (HGP) in association with scoliosis has been reported in both orthopaedic and ophthalmological published work. Juvenile progressive scoliosis in combination with HGP is caused by a malfunction of the normal control mechanism for equilibrium related to the lower brain stem, mostly associated with ROBO3 gene mutation. The aim of this study is to establish the association of scoliosis and HGP. Methods. 13 cases (four families and three sporadic cases) with HGP and scoliosis were documented; other systemic and ocular associated findings were identified and genetic counselling was done. All patients had radiograph of the spine, cranial and spinal cord MRI, chromosome analysis, gene analysis, and full ophthalmological examination. Blood samples were tested for ROBO3 gene mutation at Engle Laboratory, USA. Results. Mean age at evaluation was 14·8 years (range 1–56). Scoliosis was of varying degree (Cobb angle range 10–65°, mean 38·4°), and horizontal pendularnystagmus of low amplitude and loss of conjugate horizontal eye movements were common in all patients. Scoliosis was early onset and progressive in all patients. Six of 11 patients underwent surgery (Cobb angle range 45–70°, mean 5·3°). There were four right thoracic, two left thoracic, three right thoracolumbar, and two left thoracolumbar curves. Two patients of the third family (cases 10 and 11) had mirror image thoracolumbar curves. Cranial and spinal MRI revealed cleft in medulla oblongata in all nine patients who underwent MRI. Two adult patients refused MRI and two infant MRI scans were suboptimal. Neurological examination was otherwise normal. Notably, the female patients of family 1 also had genital dysgenesis. This is the first report of this finding in association with HGPPS, and its significance is not yet known. Homozygous ROBO3 mutations were identified in affected members of all four families, despite no recognised consanguinity in two of the families. Two were homozygous nonsense mutations (G456X and W635X) and two families shared the same missense mutation (S1107R). Two of the three sporadic cases underwent mutation testing; one harboured a homozygous missense C901R mutation, whereas a mutation was not detected in the second (patient 4). There were no distinguishing features of patient 4, suggesting that she has a non-coding mutation or that there is a second HGPPS gene. Conclusions. Every child with HGP should be evaluated for a possibly associated scoliosis, which is a progressive condition. Our cases and other published work clearly indicate that even if scoliosis is not present at first evaluation, longitudinal follow-up will show the evolution and progression of scoliosis. ROBO3 mutation testing should be done

The human amniotic membrane (hAM) contains cells of stem cell characteristics with low immunogenicity and anti-inflammatory properties and has for centuries been applied in the clinics especially for ophthalmology and wound care. It has recently been shown to be promising for novel applications such as tissue engineering and regenerative medicine. Towards these novel applications, we have demonstrated the potential of hAM in toto to differentiate towards bone, cartilage, Schwann like cells and recently also a producer of surfactant. We have further investigated the relevance of the location of origin for the therapeutic potential of the membrane. We show that placental and reflected hAM differs distinctly in morphology and functional activity. The placental region has significantly higher mitochondrial activity, however lower levels of reactive oxygen species, which suggests that placental and reflected regions may have different potential for tissue regeneration. We have further investigated the suitability of hAM to support therapeutic cells and have improved its maintenance in vitro towards xeno-free conditions

Aim. Research projects are a compulsory part of the postgraduate curriculum in most Academic Departments. To not only fulfil study requirements, but to ensure noteworthy and accurate results meticulous and reliable data collection is necessary. Our aim was to better understand what preferences health care professionals have in undertaking data collection. Methods. We did a choice based conjoint analysis with an online data collection survey. This study type allows the evaluation of the relative importance of component attributes. We used 4 major criteria to evaluate preferences when performing data collection. These were: 1. Time to complete the form, 2. Remuneration and recognition, 3. Study design and 4. Responsibilities at the time of collection. We sent electronic questionnaires to doctors in the Orthopaedic, Ophthalmology and Plastic Surgery Departments at a Johannesburg Academic Institution. Results. We received 68 responses. In general the most the most alluring trait to a data collection form is Tick Box Answer format. This is followed by the need to be recognized as a co-author on publication and the completion of forms in a time other than during work. The amount of time it takes is the least important. Recognition as a co-author of a study was more important than financial remuneration. The major difference between the 34 Orthopaedic respondents and the rest was that they were less likely to complete forms in their spare time and are less concerned with the time taken. Regressional analysis shows that data collection design must be tailored to specific groups as there are preference differences. NO DISCLOSURES

Systemic inflammatory conditions frequently affect both the small joints of the hand and the eye. Uveitis and scleritis is common in this group and patients are required to apply regular eye drops. Ophthalmic conditions are also common in patients with Osteoarthritis of the thumb CMCJ who have weakness and pain on pinch grip. Poor compliance with therapy due to difficulties in administering eye drops can cause permanent ocular and visual morbidity. A laboratory based biomechanical study was performed to replicate the pinch forces applied to the 20 most frequently used eye drops. The minimum force required to disperse a drop from a full bottle held in the inverted vertical position was assessed on three occasions by placing the eye drop bottles between a finger and thumb simulator attached to a load cell. Recordings of two bottle types were repeated using 2 different ergonomic ‘aids’ produced by the pharmaceutical companies. The data was compared to published data for pinch strength of general ophthalmology patients and to collected data for patients with thumb base CMCJ osteoarthritis. Compressive forces varied significantly between different eye drop types from 6.4 newtons (Systane) to 20.8 newtons (Minims). The highest values were found in minims which is the most frequently used eye drop. The use of the Xalatan aid appeared to increase the force required from 7.7(+/−0.64) to 12.9 (+/−3.93) but this difference did not reach significance, p=0.08, the results for Allegan aid showed no significant difference 11.3(+/−0.91) to 9.9 (+/−1.18)p=0.17. The forces required to disperse a drop increased as the bottles became less full. Forces required to disperse eye drops from bottles varies considerably and can be greater than the maximum pinch pressure of some patient groups which may be a cause of poor compliance. Some ergonomic aids designed to help with the application of drops do not appear to reduce the forces required

Surgical training in the UK since the Second World War has developed into a world class education programme. However, with the dramatic increase in the number of doctors and surgeons, combined with the improvement in access to health care, pathologies are now being treated earlier, and trainee exposure to advanced pathology has consequentially reduced. Not all countries are as privileged as the UK to have 3 doctors per 1000 head of population; South Africa has approximately 1/3rd of this number, Cambodia 1/10. th. , and Malawi 1/100. th. Many of these countries have difficulty filling posts for medical professionals within their own hospitals. The publication of the CRISP report and Lord Crisp's subsequent book ‘Turning the world upside down’ in 2010, highlighted, and tried to produce evidence of the mutual benefit of international health links to both the developed and the developing countries. It cited the bilateral transfer of skills and ideas, development of management skills, and improved workforce morale as beneficial effects of such links. The Department for International Development has prioritised the formation of these international partnerships. The Tropical Health Education Trust has been given the task of distributing grant funds. There are over 100 currently established and funded different health links across the UK. Some local links already exist such as the Gloucester NHS Trust Kambia, Sierra Leone link which focuses on maternal health, NHS South Centrals leadership programme which has a broader remit and works in conjunction with the ministries of health in certain areas of Tanzania and Cambodia and UHB/BRI link with Mbarara, Uganda in obstetrics, child health, ophthalmology. Over the last 4 years, a series of South West Trainees have spent 1 year working in hospitals in Malawi and South Africa. The positive feedback that they have given, the dramatic increase in the surgical exposure as documented in their log books, and the number of high quality research projects that they have published as a result, has led to the programme director looking favourably on future requests. We feel it would be mutually beneficial to formalise these links, with a regular stream of surgeons from this region spending time in these hospitals. Benefits for the recipient hospital would be a dependable and regular supply of staff, who could be incorporated into more long scale programmes, aimed at improving regional health care. Benefits to the donor institution and surgeon would be streamlined application process, simpler living logistics, car house etc, continuity of research projects, and the possibility to apply for funding for local research staff

Aims

Machine-learning (ML) prediction models in orthopaedic trauma hold great promise in assisting clinicians in various tasks, such as personalized risk stratification. However, an overview of current applications and critical appraisal to peer-reviewed guidelines is lacking. The objectives of this study are to 1) provide an overview of current ML prediction models in orthopaedic trauma; 2) evaluate the completeness of reporting following the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement; and 3) assess the risk of bias following the Prediction model Risk Of Bias Assessment Tool (PROBAST) tool.

Aims

The use of 3D printing has become increasingly popular and has been widely used in orthopaedic surgery. There has been a trend towards an increasing number of publications in this field, but existing literature incorporates limited high-quality studies, and there is a lack of reports on outcomes. The aim of this study was to perform a scoping review with Level I evidence on the application and effectiveness of 3D printing.

Objectives

Sustained intra-articular delivery of pharmacological agents is an attractive modality but requires use of a safe carrier that would not induce cartilage damage or fibrosis. Collagen scaffolds are widely available and could be used intra-articularly, but no investigation has looked at the safety of collagen scaffolds within synovial joints. The aim of this study was to determine the safety of collagen scaffold implantation in a validated in vivo animal model of knee arthrofibrosis.

The October 2012 Wrist & Hand Roundup³⁶⁰ looks at: osteoarticular flaps to the PIPJ; prognosis after wrist arthroscopy; adipofascial flaps and post-traumatic adhesions; the torn TFCC alone; ulna-shortening osteotomy for ulnar impaction syndrome; Dupuytren’s disease; when a wrist sprain is not a sprain; and shrinking the torn intercarpal ligament.