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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_2 | Pages 76 - 76
1 Mar 2021
Peters J Wickramarachchi L Thakrar A Chin K Wong J Mazis G Beckles V
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Abstract

Objectives

Our objective was to determine the incidence of post-operative COVID-19 infection within the first two weeks following treatment at the COVID-free site. During the COVID-19 pandemic our hospital saw one of the highest rates of COVID-19 infection in the United Kingdom. As a result, our trauma services were relocated to a vacant private elective hospital to provide a ‘COVID-free’ setting for trauma patients. Patients admitted to the COVID-free site were screened for coronavirus infection and only treated at that site if asymptomatic. Those with symptoms were treated at the ‘COVID’ site.

Method

We collected data at the COVID-free site during the first seven weeks of its’ establishment. Inclusion criteria were all patients presenting for operative management of limb trauma; however, fragility hip fractures were excluded. All patients were screened for symptoms of COVID-19 infection at their 2-week follow-up appointment.


Bone & Joint Open
Vol. 1, Issue 6 | Pages 316 - 325
23 Jun 2020
Thakrar A Raheem A Chui K Karam E Wickramarachchi L Chin K

Aims

Healthcare systems have been rapidly restructured to meet COVID-19 demand. Clinicians are working to novel clinical guidelines, treating new patient cohorts and working in unfamiliar environments. Trauma and orthopaedics (T&O) has experienced cancellation of routine clinics and operating, with redistribution of the workload and human resources. To date, no studies have evaluated the mental health impact of these changes on the T&O workforce. We report the results of a novel survey on the impact of the pandemic on the mental health of our orthopaedic workforce and the contributory factors.

Methods

A 20-question survey-based cross-sectional study of orthopaedic team members was conducted during the COVID-19 pandemic. The primary objective was to identify the impact of the pandemic on mental health in the form of major depressive disorder (MDD) and general anxiety disorder (GAD). The survey incorporated the patient health questionnaire (PHQ-2), which is validated for screening of MDD, and the generalized anxiety disorder questionnaire (GAD-2), which is validated for screening of GAD.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_5 | Pages 5 - 5
1 May 2015
Peek A Timms A Wartemberg G Chin K Calder P Goodier D
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Several low energy osteotomy techniques are described in the literature but there is limited evidence comparing healing indices. We present a retrospective review of two techniques to evaluate an optimum method.

Method:

Two cohorts of patients underwent osteotomy of the tibia using a Gigli saw (n=15) or DeBastiani corticotomy (n=12) technique. Indications for surgery included limb lengthening and bone transport for defect reconstruction with a minimal distraction of 2 cm. The patient radiographs were anonymised and the regenerate assessed by the two senior authors who were blinded to the osteotomy type. Bone quality was recorded along the anterior, posterior, medial and lateral cortices, graded 1–5 from absent to full consolidation over time in frame. The time to 3 cortices healed/regenerate length was calculated. The time to consolidation of the anterior, posterior, medial and lateral cortices were compared.

Results:

The mean 3 cortices index in the Gigli group was 2.0 months/cm and in the DeBastiani group 1.8 months/cm, This was not a significant difference. In both groups anterior bone formation was slower, and in 50% and 33% of the Gigli and DeBastiani groups respectively the anterior cortex did not fully heal by the time of frame removal.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_6 | Pages 2 - 2
1 Apr 2014
Balaji V Chin K Samir F Kouklinos A Tucker S Shaw M
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Aim:

Vitamin D deficiency is a common problem in the UK. It is more prevalent in patients with orthopaedic conditions. Previous studies in the literature have shown that vitamin D deficiency is associated with low patient-related outcome scores. To date, no studies have been performed in spinal patients. The aim of this study was to investigate whether there is a relationship between vitamin D status and pre-operative outcome scores in patients with AIS.

Methods:

AIS patients undergoing scoliosis correction between July 2012 and May 2013 at the Royal National Orthopaedic Hospital were investigated. Serum 25-hydroxyvitamin D levels were measured and SRS-22r questionnaires were completed as part of their pre-admission work up.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 89 - 89
1 May 2011
Nawabi D Chin K Keen R Haddad F
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Introduction: The presence of low levels of vitamin D in osteoarthritic patients has been reported as a substantial problem. We are not aware of any previous studies that have assessed the function of osteoarthritic patients undergoing joint replacement who are vitamin D deficient. This may be an important factor infiuencing preoperative function and postoperative outcome. The aim of this study was to investigate whether low vitamin D levels are associated with functional deterioration in patients with osteoarthritis of the hip undergoing total hip arthroplasty.

Methods: We measured plasma 25-hydroxyvitamin D3 (25(OH)D3) levels in 62 consecutive Caucasian patients undergoing total hip arthroplasty for osteoarthritis. The patients were divided into two groups based on whether they were vitamin D sufficient or deficient. The groups were matched for age, gender and ASA grade.

Results: The prevalence of vitamin D deficiency in our cohort of patients was comparable to recent population-based studies performed in the UK. Patients with vitamin D deficiency had lower preoperative Harris hip scores (Mann-Whitney test, p = 0.018) and were significantly less likely to attain an excellent outcome from total hip arthroplasty (Chi-square test, p = 0.038). Vitamin D levels were found to positively correlate with both preoperative and postoperative Harris hip scores.

Discussion: Our results warrant further study of vitamin D deficiency in patients undergoing joint replacement as it is a risk factor for suboptimal outcome which is relatively simple and cheap to correct.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 350 - 350
1 May 2010
Chin K Gella S Killampalli V Singh B
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Introduction: Early plaster immobilisation is important in fracture management to control pain and maintain alignment. In our institute, the initial plaster is routinely applied by junior trainees directly or is applied by Accident & Emergency (A& E) staff under the supervision of the junior trainees. In the U.K., plaster application technique has not been routinely and formally taught to the junior trainees in the hospital.

Method: We aimed to review the adequacy of plaster applied or supervised by junior trainees. The criteria for an adequate of plaster immobilisation for tibial diaphyseal fractures have not been reported in the literature. We had chosen 3 simple parameters, namely, change in alignment of fracture fragments, position of the ankle and a gap index of less than 0.15, which in our view are important in terms of initial management of tibial fracture in the A& E. The gap index reflects the amount of padding applied in the plaster. These parameters were merely chosen to assess the adequacy of initial plaster immobilisation by junior trainees and should not predict the long term success or failure of the management of fracture with plaster. Sixty-five patients with tibial diaphyseal fractures were retrospectively included in the present study. The initial and post-plaster application radiographs were assessed by two senior trauma & orthopaedic specialist registrars separately.

Result: Only forty-six percent (45%) of the cases had fulfilled all the three criteria. In subgroup analysis, position of the ankle is the most frequently neglected factor with 31% of the ankles held in equinus. Twenty eight percent (28%) of cases had worsening of the alignment of the fracture fragments. Fourteen percent (14%) of the cases had excessive padding applied as reflected by Gap Index of > 0.15.

Conclusion: This study highlighted that the basic plastering technique by the junior trainees is inadequate. We suggest that every trainee rotating to Trauma & Orthopaedic Surgery must be taught this fast-fading away basic plaster application technique during the induction period.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 276 - 276
1 May 2010
Chin K Gogi N Fulcher G Deshmukh S Shepherd D
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Introduction: Fracture of cortical long bone can be treated with open reduction and internal fixation. Although the lag-screw technique would provide a stronger compression across the fracture site, this may not translate directly into a significantly better mechanical stability of the construct. In narrow long bone such as the metacarpus, it may be technically difficult to over-drill the near cortex. In addition, the fracture configuration as well as the presence of soft tissue attachment and neurovascular bundle in such smaller bones may give rise to technical difficulty in fixation with all the screws from the same side.

Hypothesis: We therefore propose to test the hypothesis that there is no difference in the mechanical stability of the construct, in terms of three points bending and axial loading, between fixation with lag screw (L) and cortical screw (1C) in long bone oblique fracture.

Secondly, we proposed that fixation with alternate cortical screws from both sides of the cortices (2C) may confer a stronger mechanical stability than fixation with all screws from one side (1C).

Method: A 12 cm long oblique osteotomy was created along the shaft of tibial saw bone to produce an artificial long oblique fracture. The two fragments were held together and precompressed similarly with reduction clamp. Lag screw technique (L), unilateral (1C) and bilateral (2C) simple cortical screws techniques were used to fix the fracture with a total of four 4.5mm cortical screw in each construct. The test piece was placed into position and compressed under displacement control using a Bose ElectroForce® 3300 Series test instrument (Bose Corporation ElectroForce Systems Group, Minnesota USA). The displacement was applied at a rate of 0.42mm/s. The displacement and load were measured every 0.0586 seconds and recorded using Win-Test Software (Bose Corporation ElectroForce Systems Group, Minnesota USA).

Result: In three-points bending, fixation with unilateral cortical screws (1C) provided the highest mean stiffness values of the three techniques with an average of 27.72 N/mm (standard deviation STD 4.90 N/mm). The lag screw technique (L) had slightly lower mean stiffness values with an average of 26.29 N/mm (STD 3.46 N/ mm). Fixation with opposing screws (2C) had a lowest mean stiffness averaging 18.31 N/mm (STD 14.49 N/ mm). In axial compression, unilateral cortical screws (1C) provided the highest average stiffness at 290.33 N/mm (STD 89.84 N/mm) The opposing pre-compression technique had an average stiffness of 241.24 N/ mm (STD 121.30 N/mm) and the lag screw technique 198.94 N/mm (STD 58.33N/mm).

Conclusion: In conclusion, fixation with unilateral cortical screws (1C) provided a better mechanical stability than lag screw. Fixation with bilateral cortical screws (2C) did not provide a more stable construct than unilateral screw fixation.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 279 - 279
1 Nov 2002
Brick G Chin K Tsahakis P
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Introduction: Diffuse pigmented villo-nodular synovitis (DPVNS) of the knee remains a difficult tumor to eradicate. We report our experience with a combined posterior and open synovectomy technique.

Method: A single surgeon operated on 40 patients averaging 35 years old (14 to 68 years). The patients were placed into one of three groups: group I received surgery alone (five patients), group II had surgery and intra-articular radiation synovectomy using Dysprosium-165 (165Dy) (30 patients), and group III had surgery and external beam radiation (5 patients). The adjuvant radiation was performed three months postoperatively. MRI evaluation was used preoperatively and post-operatively.

Results: The average combined Knee Society Scores and range of motion improved. Thirty-seven patients (92.5%) had a good or excellent results; two (5%) had a fair result; and one (2.5%) had a poor result. There were seven recurrences (17.5%). None occurred in group I; five occurred in group II (12.5%); and two occurred in group III (5%).

Discussion & Conclusions: This technique allowed excellent visualisation and removal of intra- and extra-articular DPVNS tissue with excellent functional results and few recurrences documented by MRI. Adjuvant intra-articular radiotherapy may be beneficial for small foci of residual disease but complete resection of all DPVNS tissue was the key to prevent recurrence. External beam radiation did not prevent recurrence and possibly predisposed patients to pain and less improvement in knee flexion. Extensive pre-operative degenerative joint disease predisposes patients to continued pain.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 281 - 281
1 Nov 2002
Chin K Brick G
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Introduction: The reconstruction of the severely deficient proximal femur is more commonly achieved with a large composite proximal femoral allograft and a prosthesis.

Aim: To review our experience with this technique in 19 revision total hip arthroplasties (18 patients) treated between December 1988 and January 1997.

Cases: There were 15 females and three males. The average age was 56 years (32 to 78 years). The primary diagnoses included osteoarthritis (seven), rheumatoid arthritis (six), congenital dislocation (two), avascular necrosis (one), septic arthritis (one), and ankylosing spondylitis (one). Each underwent an average of three (range: one to 9) previous hip operations. The average time from the previous operation was 10.65 years (0.25 to 25). All hips had significant periprosthetic osteopenia and bone loss on preoperative radiographs. Five had previous infections with two subsequent Girdlestone arthroplasties. Six presented with periprosthetic fractures and loose components.

The hips were approached posteriorly. A step cut was used to secure the host to allograft junction. The femoral component was cemented within the allograft and with a press-fit in the host bone. All but three cases had iliac crest bone graft and/or residual host bone chips added to the host-allograft site. The acetabulum was revised concurrently in 13 (two whole acetabular allografts).

Results: The average period of follow-up was 57.6 months(range: 25 to 127 months). The time taken to heal was estimated radiographically as less than 8.5 months (range: three to 18 months). The average Harris Hip Scores improved from 25.6 to 75.53. One patient complained of persistent pain post-operatively. The complications included proximal migration of the greater trochanter in five, one infection that was converted to a Girdlestone excisional arthroplasty 27 months later, and seven patients with dislocations.

Conclusions: Allograft prosthetic reconstruction of the proximal femur is a durable construct with up to ten years follow-up. This technique preserved host bone while providing additional bone for future reconstruction. There was substantial improvement in function with low complication rates.