There are reports of good early results in small numbers of patients implanted with the ‘Moje’ ceramic prosthesis. Published evidence thus far involves only small groups of patients with short-term follow-up. The purpose of this prospective study was to evaluate the emerging mid-term clinical and radiological results from our centre. We describe our single-surgeon experience of 63 components in 48 patients at a mean follow-up of 44 months. Patient satisfaction was assessed by questionnaire and radiographic assessment was performed immediately post-operatively and at the maximum follow-up.Background
Methods
With increased shift working, multiple hand-overs, demand for trauma beds frequently outstripping supply, split-site working, shared care with other specialties and tertiary referrals awaiting transfer, keeping track of trauma patients can be difficult. To solve this problem we developed the Virtual Trauma Orthopaedic Management System (VTOMS) to monitor pre-operative trauma inpatients. VTOMS is a secure, networked system linked to the patient administration system (PAS). It can be accessed by the entire multidisciplinary team from any PC in the Trust. The main information is also displayed on plasma screens in the trauma unit. The status of patients requiring surgery is displayed (e.g. fit and ready, awaiting investigation, or unfit) with alerts on acutely unwell or unstable patients. Further details can be obtained by ‘drilling down’. The system has an inbuilt patient clock which ‘traffic lights’ patients awaiting theatre, providing a visual warning if waiting time is prolonged. Amber is set at 48 hours and red is 72 hours for most injuries. This facilitates real-time management of the trauma workload, allowing extra resources to be deployed early if it is seen that waiting times are climbing, or the case-mix is particularly complex. After successful use on trauma inpatients, the VTOMS system was extended to create a ‘virtual trauma ward’ where patients are pre-assessed in hospital and, if clinically appropriate, wait at home until a suitable theatre slot becomes available. The patient is contacted daily to monitor their clinical situation and brought in fasting on the morning of surgery. Using this ‘just in time’ philosophy 195 patients passed through our ‘virtual trauma ward’ in the six months to December 2009. The reduced length of stay saved 514 bed days, equivalent to £115,650 (£231,300 per annum), and minimised the impact of trauma on the elective service.
Every trainee in Trauma and Orthopaedics (T&O) in the UK and Ireland records their operative experience via the Faculty of Health Informatics eLogbook. Since August 2009, all doctors were subject to the full European Working Time Directive (EWTD) restrictions of 48 hours of work per week. We have previously shown that the implementation of shift working patterns in some units in preparation for these restrictions reduced training opportunities by 50% (elective surgical exposure). We have now analysed the national data to establish whether operative experience has fallen since August 2009. All operative data recorded nationally by trainees (all years, all supervision levels) between the 3 months of August to October 2007, 2008 and 2009 were compared. Data were available for 1091 ‘validated’ training grade surgeons (ST3-8 or equivalent) in 2007, 1103 in 2008 and 767 in 2009. Mean operative figures were calculated per trainee for each of the 3-month time periods.Background
Methods
The treatment of relapsed clubfeet presents a significant challenge. The Ilizarov method of gradual correction has been shown to provide satisfactory outcome. Since 2001 we have employed a newer differential soft tissue distraction using an Ilizarov frame in relapsed feet based on the Ponseti principles. The aim of our study was to analyse the outcome of this treatment. All feet treated with soft tissue distraction only were studied. The feet were assessed using international clubfoot study group evaluation, pedobarography, and gait analysis, X-rays and ASK (activity scale for kids) questionnaire.Aim
Material and Methods
Anterior cruciate ligament (ACL) reconstruction has traditionally been performed using a single bundle (SB) technique, providing good to excellent results in most cases . There is some evidence from biomechanical studies that double bundle (DB) techniques may improve anteroposterior and rotational stability. A number of prospective randomised trials have been performed producing conflicting results. The aim of this study was to find out any differences in outcome between single bundle and double bundle ACL reconstruction. A systematic review was performed to compare the evidence pertaining to the outcomes of double bundle versus single bundle ACL reconstruction methods. Medline (1966 onwards), EMBASE (1980 onwards) and the Cochrane database were searched, retrieving 9,568 possible articles. Only 6 studies fulfilled all the inclusion criteria. To be included, the study had to be prospective and randomised, comparing double bundle and single bundle grafts inserted using an arthroscopically assisted technique and have a minimum 12 month follow-up period for all patients. Analysis was performed using Review Manager (RevMan) [Computer program]. Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008. Five hundred and sixty patients (341 single bundle and 219 double bundle reconstructions) were considered for statistical analysis from these six papers. There was a significant difference between the groups with the double bundle reconstruction showing less of pivot shift positivity (P< 0.03). The DB group had significantly greater antero-posterior stability on KT arthrometer testing (P=0.002). Double bundle ACL reconstruction improved both antero-posterior and rotational stability. There was also significant improvement in IKDC scores in patients with double bundle ACL reconstruction compared to single bundle reconstruction.
