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Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 259 - 259
1 Sep 2005
Brinsden MD Lee AS Regan MW
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Introduction We performed an audit of tunnel position in primary anterior cruciate ligament reconstructions performed by two surgeons at a single centre. The audit cycle was opened with a retrospective review of a cohort of patients in order to establish existing surgical practice. Following this review our practice changed with the use of intra-operative image intensifier to confirm tunnel positions. The audit loop was closed with a prospective study of a second cohort of patients undergoing surgery using the new technique.

Results Twenty five patients were reviewed in each group. The case-mix for the two groups were similar with regard to age, sex, side, graft selection and surgical technique. The first cohort of patients had optimal tibial tunnel placement in 56% (sagittal) and 88% (coronal) of cases. The femoral tunnel was correctly positioned in the sagittal plane in 52% of patients. The second cohort, in which an intra-operative image-intensifier was used, had optimal tunnel position for the femur in 100% of cases and for the tibia (sagittal) in 48% of patients.

Conclusion In this study we have shown that the use of an image intensifier, intra-operatively, greatly improved femoral tunnel position but had no significant effect on tibial tunnel placement. We have also demonstrated that audit is effective in improving clinical practice.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 129 - 129
1 Feb 2003
Brinsden MD Mercer SJ Rawlings ID
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The risk of venous thromboembolism following surgery, with its associated morbidity and mortality, means it forms an important part of informed consent for a surgical procedure. The risk of thrombo embolic complications extends beyond the post-operative hospital stay. Patients suffering such a complication after discharge are generally not re-admitted under the care of the operating surgeon.

A retrospective opening loop audit was undertaken to investigate the communication of post-operative thrombo embolic complications between specialities in a large district general hospital. The operating surgeon was unaware of 87% of cases of pulmonary embolism and 20% of cases of deep vein thrombosis affecting patients in their post-operative period. The inter-specialty communication of post-operative complications is important to maintain a high standard of patient care and allow surgeons to make informed decisions about clinical practice.