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Bone & Joint Open
Vol. 1, Issue 10 | Pages 645 - 652
19 Oct 2020
Sheridan GA Hughes AJ Quinlan JF Sheehan E O'Byrne JM

Aims

We aim to objectively assess the impact of COVID-19 on mean total operative cases for all indicative procedures (as outlined by the Joint Committee on Surgical Training (JCST)) experienced by orthopaedic trainees in the deanery of the Republic of Ireland. Subjective experiences were reported for each trainee using questionnaires.

Methods

During the first four weeks of the nationwide lockdown due to COVID-19, the objective impact of the pandemic on each trainee’s surgical caseload exposure was assessed using data from individual trainee logbook profiles in the deanery of the Republic of Ireland. Independent predictor variables included the trainee grade (ST 3 to 8), the individual trainee, the unit that the logbook was reported from, and the year in which the logbook was recorded. We used the analysis of variance (ANOVA) test to assess for any statistically significant predictor variables. The subjective experience of each trainee was captured using an electronic questionnaire.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_1 | Pages 2 - 2
1 Jan 2016
Abdulkarim A Moriarity A Sheehan E
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Introduction

Surgical gloves function as a mechanical barrier that reduces transmission of body fluids and pathogens from hospital personnel to patients and vice versa. The effectiveness of this barrier is dependent upon the integrity of the glove. Infectious agents have been shown to pass through unnoticed glove microperforations which have been correlated to the duration of wear. Varying factors may influence the integrity of the glove such as the material, duration of use, activities and fit. Studies have recommended changing gloves 90 minutes into a general surgical operation, however there are no known EBM recommendations in orthopaedic surgery.

Objectives

The aim of our study was to determine whether the intrinsic properties of sterile surgical gloves can be compromised when exposed to common orthopaedic materials in the operating theatre.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_1 | Pages 3 - 3
1 Jan 2016
Abdulkarim A Krause K Sheehan E
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Introduction

Tourniquets have been used for many years during total knee arthroplasty as a means of achieving a bloodless field for better visualization and cement-bond inter-digitation. Controversy has surrounded the necessity for a tourniquet in past years. There are many advantages and disadvantages to using a tourniquet, and one prominent disadvantage is a purported increase in post-operative pain and limitations in range of motion.

Objective

This study examined the literature for assessment of pain and analgesia usage in post-operative patient who have either received no tourniquet during surgery or received variations in both timing and pressure. Secondary outcomes included were functional in nature, namely range of motion and post-operative hospital stay.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_1 | Pages 1 - 1
1 Jan 2016
Abdulkarim A Moriarity A Coffey P Sheehan E
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Introduction

The role of diathermy in orthopaedic surgical practice has increased since its introduction. It is widely used for underlying tissue dissection, cutting, and haemostasis. Previous studies have compared electrosurgical and scalpel incisions in terms of wound infection, wound-related pain, and blood loss. There are well documented hazards associated with diathermy use including burns injury, electrocution, hypoxic stress, inhalation of diathermy plume, and gene mutation. No single study to date has focused on the potential for diathermy tips to cause wound contamination and infection. We sought to identify whether diathermy tips could be possible sources of infection in orthopaedic procedures.

Objectives

To determine the prevalence of bacterial contamination of diathermy tips during orthopaedic surgery and to assess any correlation with surgical site infections.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_15 | Pages 1 - 1
1 Dec 2015
Abdulkarim A Moriarity A Coffey P Sheehan E
Full Access

The role of diathermy in orthopaedic surgical practice has increased since its introduction. It is widely used for underlying tissue dissection, cutting, and haemostasis. Previous studies have compared electrosurgical and scalpel incisions in terms of wound infection, wound-related pain, and blood loss. There are well documented hazards associated with diathermy use including burns injury, electrocution, hypoxic stress, inhalation of diathermy plume, and gene mutation. No single study to date has focused on the potential for diathermy tips to cause wound contamination and infection. We sought to identify whether diathermy tips could be possible sources of infection in orthopaedic procedures.

To determine the prevalence of bacterial contamination of diathermy tips during orthopaedic surgery and to assess any correlation with surgical site infections.

From July 2013 to September 2013, the diathermy tips from 86 consecutive orthopaedic procedures using diathermy were cultured using direct and enriched media. None of the diathermy tips were used for the skin incision. All patients underwent an orthopaedic procedure for a non-infected condition. For each procedure an unused control diathermy tip was placed on the instrument table at the beginning of the procedure and processed similarly. All patients were followed for any postoperative complications.

108 diathermy tips from 86 orthopaedic procedures were cultured. None of the tips cultured directly on blood agar demonstrated bacterial growth. Following enrichment culture, 6 (5.6%) of the procedure diathermy tips and 1 (0.92%) of the control tips demonstrated bacterial growth. Coagulase-negative staphylococci (83.3%) and proprionibacterium (16.7%) were cultured from the tips. 1 of the patients who had bacterial growth from the diathermy tip developed a superficial surgical site infection.

Surgical site infections contribute substantially to orthopaedic surgical morbidity and mortality each year. The prevention of these infections encompasses careful operative technique, preoperative antibiotics, and a number of important measures to minimize the risk of bacterial contamination posed by operative staff, the operating theatre environment, and the patient's endogenous skin flora. Identifying potential bacterial sources is an important component of surgery. The two bacteria cultured in our study (coagulase-negative staphylococci and proprionibacterium) are both well known major culprits in orthopaedic infections, responsible for up to 70% of early and late peri-prosthetic infections. Our study suggests diathermy tips and the tissue coagulated by its use may not be as sterile as previously thought. There may be benefit in changing the diathermy tips during orthopaedic procedures as they may represent a possible source of bacterial contamination.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_10 | Pages 8 - 8
1 Jul 2014
Carmody O Sheehan E McGrath R Keeling P
Full Access

An interesting case with excellent accompanying images, highlighting the significance of tourniquets in controlling exsanguination, whilst also raising the issue of amputation versus reconstruction in severely injured limbs.

A 39 year old male motorcyclist was BIBA to the Midland Regional Hospital in Tullamore, following a head-on collision with a bus at high velocity. On arrival, he was assessed via ATLS guidelines; A- intubated, B- respiratory rate 32, C - heart rate 140bpm, blood-pressure 55/15 and D- GCS 7/15. Injuries included partial traumatic amputation of the right lower limb with clearly visible posterior femoral condyles, a heavily comminuted distal tibial fracture and almost complete avulsion of the skin and fat at the popliteal fossa. Obvious massive blood loss at the scene had been tempered by a passer-by who applied a beach towel as a makeshift tourniquet. CT Brain demonstrated extra-dural and subarachnoid haemorrhages with gross midline shift. Unfortunately, the neurosurgical team in Beaumont concluded that surgical intervention would be inappropriate. However, his kidneys had not sustained ATN and were made available for donation.

Two vital surgical issues were featured in this case. Firstly, it highlighted the importance of tourniquets in controlling exsanguination in a trauma situation1. Secondly, it raised the critical issue of amputation versus reconstruction in severely injured limbs2,3.

Without prompt placement of a make-shift tourniquet by a passer-by, this patient would have almost certainly died at the scene of the accident. Two kidneys were successfully donated as a result.

The importance of appropriate tourniquet use cannot be overstated. This case highlights its potential life or limb-saving capabilities in emergency trauma situations. It also raises the critical issue of amputation versus reconstruction in acute emergency situations.