Traditionally, sports Injuries have been sub-optimally managed through Emergency Departments (ED) in the public health system due to a lack of adequate referral processes. Fractures are ruled out through plain radiographs followed by a reactive process involving patient initiated further follow up and investigation. Consequently, significant soft tissue and chondral injuries can go undiagnosed during periods in which early intervention can significantly affect natural progression. The purpose of this quality improvement project was to assess the efficacy of an innovative Sports Injury Pathway introduced to detect and treat significant soft tissue injuries. A Sports Injury Pathway was introduced at Fiona Stanley Hospital (WA, Australia) in April 2019 as a collaboration between the ED, Physiotherapy and Orthopaedic Departments. ED practitioners were advised to have a low threshold for referral, especially in the presence of a history of a twisting knee injury, shoulder dislocation or any suggestion of a hip tendon injury. All referrals were triaged by the Perth Sports Surgery Fellow with early follow-up in our Sports Trauma Clinics with additional investigations if required. A detailed database of all referrals was maintained, and relevant data was extracted for analysis over the first 3 years of this pathway. 570 patients were included in the final analysis. 54% of injuries occurred while playing sport, with AFL injuries constituting the most common contact-sports injury (13%). Advanced Scope Physiotherapists were the largest source of referrals (60%). A total of 460 MRI scans were eventually ordered comprising 81% of total referrals. Regarding Knee MRIs, 86% identified a significant structural injury with ACL injuries being the most common (33%) followed by isolated meniscal tears (16%) and multi-ligament knee injuries (11%). 95% of Shoulder MRI scans showed significant pathology. 39% of patients required surgical management, and of these 50% were performed within 3 months from injury. The Fiona Stanley Hospital Sports Injury Pathway has demonstrated its clear value in successfully diagnosing and treating an important cohort of patients who present to our Emergency Department. This low threshold/streamlined referral pathway has found that the vast majority of these patients suffer significant structural injuries that may have been otherwise missed, while providing referring practitioners and patients access to prompt imaging and high-quality Orthopaedic sports trauma services. We recommend the implementation of a similar Sports Injury Pathway at all secondary and tertiary Orthopaedic Centres.
Meniscal repair is an accepted surgical option for meniscal tears. However, there remains trepidation with regard to offering such surgery to older patients. We aim to evaluate the outcomes in these such patients. A single surgeons log was used to identify patients who underwent meniscal repair and were over the age of 40. Patients having concurrent anterior cruciate ligament reconstructions were excluded. Demographic data, surgical data and outcomes (pain visual analogue score (VAS); single assessment numerical evaluation (SANE) and knee injury and osteoarthritis outcome joint replacement (KOOS Jr) score) were collected prospectively. Final outcomes were collected between 6–12 months following surgery.Abstract
Introduction
Methodology
The incidence of significant acute chondral injuries with patella dislocation is around 10–15%. It is accepted that chondral procedures should only be performed in the presence of joint stability. Patients were identified from surgeon/hospital logs. Patient demographics, lesion size and location, surgical procedure, patient reported outcome measures, post-operative MR imaging and complications were recorded. PROMs and patient satisfaction was obtained.Abstract
Introduction
Methodology
We would like to present this service evaluation of Taylor Spatial Frame use within a busy limb reconstruction unit. We present a cohort of 60 patients representing a year of work from January 2011 to January 2012 with a breakdown of coding data. Included are details of operative episodes, length of stay, outpatient follow up including software programming episodes, strut changes and general frame care from our specialist nurses. We have produced a comparison of cost to HRG coding tarifs with an audit of coding errors and cost implications of these corrections. Also included is a breakdown of comparison data from patients undergoing frame assisted deformity correction and internal fixation, Computer Hexapod Assisted Orthopaedic Surgery. Exact and careful coding of these procedures is required considering their relatively high cost.
Glenohumeral arthritis is associated with eccentric posterior glenoid wear and subsequent retroversion. Total shoulder arthroplasty provides a reliable and robust solution for this pattern of arthritis but success may be tempered by malposition of the glenoid component, resulting in pain, functional impairment, prosthetic loosening and ultimately failure. Correction of glenoid retroversion through anterior eccentric reaming, prior to glenoid component implantation, is performed to restore normal joint biomechanics and maximise implant longevity. The aim of this study was to assess whether magnetic resonance imaging (MRI) or plain axillary radiography (XR) most accurately assessed glenoid version and hence provided the optimal modality for pre-operative templating. Glenoid version was assessed in pre-operative shoulder MRIs and axillary radiographs (XR) by two independent observers in forty-eight consecutive patients undergoing total shoulder arthroplasty. The mean glenoid version measured on magnetic resonance imaging was −14.3 degrees and −21.6 degrees on axillary radiographs (mean difference −7.36, p=<0.001). Glenoid retroversion was overestimated in 73% of XRs. Intra-observer and inter-observer reliability coefficients for MRI were 0.96 and 0.9 respectively. Intra-observer and inter-observer reliability coefficients for XR were 0.8 and 0.71 respectively. Axillary radiographs significantly overestimate glenoid retroversion and are less precise than shoulder magnetic resonance, which provides excellent intra- and inter-observer reliability. MRI is a useful pre-operative osseous imaging modality for total shoulder arthroplasty as it offers a more precise method of determining glenoid version, in addition to the standard assessment rotator cuff integrity.
