Aims. In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within
Aims.
The use of artificial intelligence (AI) is rapidly growing across many domains, of which the medical field is no exception. AI is an umbrella term defining the practical application of algorithms to generate useful output, without the need of human cognition. Owing to the expanding volume of patient information collected, known as ‘big data’, AI is showing promise as a useful tool in healthcare research and across all aspects of patient care pathways. Practical applications in
The number of women entering medical school has been steadily increasing over the past two decades; however, the number of women pursuing careers in
Aims. The use of fluoroscopy in
Aims. Sarcopenia is characterized by a generalized progressive loss of skeletal muscle mass, strength, and physical performance. This systematic review primarily evaluated the effects of sarcopenia on postoperative functional recovery and mortality in patients undergoing
Abstract. Introduction. The NHS generates 4–5% of the nation's total carbon emissions and over 500,000 tonnes of waste annually. Up to one-third of waste from orthopaedic procedures are recyclable, with large joint arthroplasties producing more than other subspecialties. However, there is limited evidence demonstrating the principles of sustainability and its benefits within
Musculoskeletal ultrasound (MSK-US) can have many uses for orthopaedic surgeons, such as assisting in clinical diagnosis for muscle, tendon and ligament injuries, providing direct guidance for joint injections, or assessing the adequacy of a reduction in the emergency department. However, proficiency in sonography is not a requirement for Royal College certification, and orthopaedic trainees are rarely exposed to this modality. The purpose of this project was to assess the usefulness in clinical education of a newly implemented MSK-US course in an
Aims. The purpose of this survey study was to examine the demographic and lifestyle factors of women currently in
Cerebral Palsy (CP) is a group of disorders that affect movement and posture caused by injury to the developing brain. While prematurity and low birth weight are common causes in developed countries, birth asphyxia, kernicterus, and infections have been identified as predominant aetiologies in Africa. There is, however, very little information on the aetiology of CP in South Africa. The purpose of this study was to determine the aetiology, severity, and topographical distribution of CP in children undergoing
The 2020-2021 Canadian Residency Matching Service (CaRMS) match year was altered on an unprecedented scale. Visiting electives were cancelled at a national level, and the CaRMS interview tour was moved to a virtual model. These changes posed a significant challenge to both prospective students and program directors (PDs), requiring each party to employ alternative strategies to distinguish themselves throughout the match process. For a variety of reasons, including a decline in applicant interest secondary to reduced job prospects, the field of
Objectives. The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and
The aim of this study was to review the role
of clinical trial networks in
Aims. Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing
Aims. The aims of this systematic review were to describe the quantity and methodological quality of meta-analyses in
Telehealth has the potential to change the way we approach patient care. From virtual consenting to reducing carbon emissions, costs, and waiting times, it is a powerful tool in our clinical armamentarium. There is mounting evidence that remote diagnostic evaluation and decision-making have reached an acceptable level of accuracy and can safely be adopted in
Robots have been used in surgery since the late
1980s.
Three-dimensional (3D) printing has become more frequently used in surgical specialties in recent years.
Abstract. Objectives. Sarcopenia is characterised by generalised progressive loss of physical performance, skeletal muscle mass and strength. This systematic review evaluated the effects of sarcopenia on postoperative functional recovery outcomes and mortality in patients undergoing
Introduction. Ischaemic preconditioning (IPC) is a phenomenon whereby a tissue is more tolerant to an insult if it is first subjected to short bursts of sublethal ischaemia and reperfusion. The potential of this powerful mechanism has been realised in many branches of medicine where there is an abundance of ongoing research. However, there has been a notable lack of development of the concept in
Introduction. There is widespread variation in the management of rare orthopaedic disease, in a large part owing to uncertainty. No individual surgeon or hospital is typically equipped to amass sufficient numbers of cases to draw robust conclusions from the information available to them. The programme of research will establish the British
The use of crude mortality and morbidity data to assess the outcome from surgical intervention can be both dangerous and misleading. Furthermore, differences in outcome when comparing differing units or surgeons may be explained merely by variations in case mix and the type of surgery. In recent years there have been a number of attempts to devise a reliable method for assessing the outcome from surgical intervention. In the general surgical setting, the POSSUM system has proved to be the most reliable and accurate of all scoring systems so far devised. It is widely applicable in other specialities as it allows comparison based on the patient’s physiological status and the magnitude of surgery. It could be used in any hospital, in elective and emergency operations. The present study attempted to validate the application of this new method of assessing the outcome after
Introduction: Surgical training is being greatly affected by the challenges of reduced training opportunities, shortened working hours, and financial pressures. There is thus an increased need for training systems to aid development of psychomotor skills of the surgical trainee. Furthermore, simulation environments can provide a friendlier and less hazardous environment for learning surgical skills. Such simulations may be used to augment training in the operating room (OR) so that trainees acquire key skills in a non-threatening and unhurried environment. Trajectory planning and implementation forms a substantial part of current and future orthopaedic practice. This type of surgery is governed by a basic orthopaedic principle where the placement of a surgical tool at a specific site within a region via a trajectory that is planned from X-ray based 2D images and is governed by 3D anatomical constraints. The accuracy and safety of procedures utilising the basic orthopaedic principle depends on the surgeon’s judgement, experience, ability to integrate images, utilisation of intra-operative X-ray, knowledge of anatomical-biomechanical constraints and eye hand dexterity. With the decrease in training opportunities in OR for the surgical trainee, these skills are developing at a much later stage in training. Several studies have shown a reduction in the number of operations undertaken and a reduction in the level of competence achieved by surgical trainees.
The study is divided into two parts. The initial part of the study involves the use of the conventional CAOSS to train the orthopaedic trainees with no prior exposure of distal locking of femoral nails and the dynamic hip screw. The second part of the study involves the use of modified CAOSS to assess whether the initial training has helped in developing mental navigation skills of using a 2-D image and navigating the drill bit in 3-D space. The scoring system is based on a combination of parameters which include the time taken for centring of the interlocking screw, total exposures taken and the improvement in the position of the tip of the drill bit with each exposure.
Excessive postoperative opioid prescribing is a significant contributor to the opioid crisis. Prescribing in
Introduction. Haemostasis is a vital, complicated process. Many standard orthopaedic operations strain the limits of this process, leading to blood transfusions. The former view is that haemostasis occurs cascade-wise in discrete steps, primary haemostasis followed by coagulation, followed by fibrinolysis. This view has been modified to the insight that although there is a temporal succession of these steps, there is also multiple ante- and retrograde interactions between the various reactions. The complexity of the haemostatic system also implies individual variance of the effectiveness of haemostasis. Minor haemostatic defects such as mild cases of von Willebrand disease probably occur in several per cent of the population. Furthermore many orthopaedic patients are on medication with ASA, NSAIDs, clopidogrel, antidepressants, warfarin and LMWH, all common drugs which affect haemostasis. Methods to reduce blood loss. Basal measures include avoidance of hypothermia, appropriate positioning of the patient, appropriate anesthesiological and surgical techniques and if possible discontinuation of unsuitable drugs. In patients with known haemostatic disorders, substitution of the deficient coagulation factors may improve haemostasis. The same holds true for patients on warfarin medication where substitution with vitamin K, with factors of the vitamin-K dependant complex or with plasma normalizes haemostasis. Desmopressin stimulates the release of factor VIII and the von Willebrand factor and thus improves platelet function in some subgroups of von Willebrand disease and in platelet dysfunction due to ASA or dextran use. However, the blood-saving effect in patients without these disorders has not been conclusively shown. In recent years the role of factor VII as a main initiator of coagulation has been stressed. Case reports of effective haemostasis in severe trauma using recombinant factor VII have been published but the experience of its use in
Aims. The aim of this study was to assess the quality and scope of the current cost-effectiveness analysis (CEA) literature in the field of hand and upper limb
Purpose: The purpose of this study was to determine the usefulness of systematic bacteriological culture of drainage fluid after aseptic
The global economy has been facing a financial crisis. Healthcare costs are spiraling, and there is a projected £30 billion health funding gap by 2020 in the UK. 1. This has prompted a drive for efficiency in healthcare provision in the UK, and in 2012, the Health and Social Care Act was introduced, heralding a fundamental change to the structure of the National Health Service, especially in the way that healthcare is funded in England. 2. What is happening in the UK is a reflection of a global problem. Rationing of healthcare is a topic of much discussion; as unless spending is capped, providing healthcare will become unsustainable. Who decides how money is spent, and which services should be rationed? . In this article we aim to discuss the impact that rationing may have on
Among the advanced technology developed and tested for
Aims: Aim of this study is to review the role of biomechanical modelling in computer aided
Introduction: There has been significant development in computer technology in recent years and this has led to applications in
Orthopaedics like all other branches of medicine is likely make tremendous scientific progress in the new millennium. The extent of this progress will depend on how we have done in last 1000 years. I feel it is important in a discussion of this nature to separate
Introduction. Technology in
Aims. The use of 3D printing has become increasingly popular and has been widely used in
Background. Surgical quality improvement has received increasing attention in recent years, yet it isn't clear where orthopaedic surgeons should focus their efforts for the greatest impact on peri-operative safety and quality. We sought to guide these efforts by prioritising orthopaedic procedures according to their relative contribution to overall morbidity, mortality, and excess length of stay. Methods. We used data from the American College of Surgeons' National Surgery Quality Improvement Program (ACS-NSQIP) to identify all patients undergoing an orthopaedic procedure between 2005 and 2007 (n=7,970). Patients were assigned to 44 unique procedure groups based on Current Procedural and Terminology codes. We first assessed the relative contribution of each procedure group to overall morbidity and mortality in the first 30 days, and followed with a description of their relative contribution to excess length of stay. Results. Ten procedures accounted for 70% of adverse events and 64% of excess hospital days. Hip fracture repair accounted for the greatest share of adverse events, followed by total knee arthroplasty, total hip arthroplasty, revision total hip arthroplasty, knee arthroscopy, laminectomy, lumbar/thoracic arthrodesis, and femur fracture repair. In contrast, no other procedure group accounted for more than 2% of morbidity and mortality. Conclusion. Only a few procedures account for the vast majority of morbidity and mortality in
The purpose of the study was to investigate the incidence of surgical site infection following elective paediatric
Polymethylmethacrylate remains one of the most enduring materials in
Aims. The aim of this study was to examine the association between
postoperative glycaemic variability and adverse outcomes following
orthopaedic surgery. Patients and Methods. This retrospective study analyzed data on 12 978 patients (1361
with two operations) who underwent
Introduction. Junior level
The credibility and creativity of an author may be gauged by the number of scientific papers he or she has published, as well as the frequency of citations of a particular paper reflecting the impact of the data on the area of practice. The object of this study was to identify and analyse the qualities of the top 100 cited papers in
Aims. Preprint servers allow authors to publish full-text manuscripts or interim findings prior to undergoing peer review. Several preprint servers have extended their services to biological sciences, clinical research, and medicine. The purpose of this study was to systematically identify and analyze all articles related to Trauma &
Objectives. The period of post-operative treatment before surgical wounds
are completely closed remains a key window, during which one can
apply new technologies that can minimise complications. One such
technology is the use of negative pressure wound therapy to manage
and accelerate healing of the closed incisional wound (incisional
NPWT). . Methods. We undertook a literature review of this emerging indication
to identify evidence within
Payments by the NHS Litigation Authority continue to rise each year, and reflect an increase in successful claims for negligence against NHS Trusts. Information about the reasons for which Trusts are sued in the field of trauma and
Introduction. The aim of this study is to report the 30 day COVID-19 related morbidity and mortality of patients assessed as SARS-CoV-2 negative who underwent emergency or urgent
Purpose: To determine the degree of burnout among resident physicians in
Introduction. Computer hexapod assisted
Introduction. Technology in
The aim of this meta-analysis was to determine based on evidence from all randomised controlled trials whether closed suction drainage is preferable to no drainage for all types of
Aims. COVID-19 has changed the practice of orthopaedics across the globe. The medical workforce has dealt with this outbreak with varying strategies and adaptations, which are relevant to its field and to the region. As one of the ‘hotspots’ in the UK , the surgical branch of trauma and orthopaedics need strategies to adapt to the ever-changing landscape of COVID-19. Methods. Adapting to the crisis locally involved five operational elements: 1) triaging and workflow of orthopaedic patients; 2) operation theatre feasibility and functioning; 3) conservation of human resources and management of workforce in the department; 4) speciality training and progression; and 5) developing an exit strategy to resume elective work. Two hospitals under our trust were redesignated based on the treatment of COVID-19 patients. Registrar/consultant led telehealth reviews were carried out for early postoperative patients. Workflows for the management of outpatient care and inpatient care were created. We looked into the development of a dedicated operating space to perform the emergency
Abstract. This project was funded by “start-up” funds by the Department of Surgery, Division of Orthopaedics, University of Toronto. Purpose. The purpose of this study was to determine the impact of an interactive workshop pertaining to optimizing learning in orthopaedics, on academic performance and changed behaviour towards learning during orthopaedic residency training. Themes included: 1) what makes learning
We evaluated the quality of guidelines on thromboprophylaxis
in
At least 10% of consultations in General Practice are for musculoskeletal problems. It would seem appropriate that the diagnosis and management of common musculoskeletal problems should form an important part of the “core” curriculum of any undergraduate medical training. Time is always short in an undergraduate teaching program and the pressures not to overload the curriculum are constant. The planned increased in student numbers is likely to stretch the ability of most teaching departments to provide a high level of undergraduate training in musculoskeletal disease. A postal survey of the provision of undergraduate teaching in T&
O was performed in the UK. All 23 medical schools in England, Scotland, Wales and Northern Ireland were. To gain further insight into non-specialist general training in T&
O after qualification a survey of the Vocational Training Schemes (VTS) for General practitioners in the Northern Deanery was performed. Ninety-one percent of Medical Schools replied. The average length of the orthopaedic attachments (all years combined) was five weeks. However, all but two programs were combined with other clinical subjects. The dilutional effect of these other subjects resulted in the average duration of the T&
O attachment being reduced to 2.7 weeks (range 1.5 – 6). All the modules in
We describe the development and validation of a scoring system for auditing
Background. Thrombosis is a rare complication for the single orthopaedic surgeon. The objective for this study was to determine the incidence of thromboembolism after
The advantages of plastics are well known, but there are still some who maintain that these materials are costly and difficult to manipulate. It is not usually remembered, however, that plastics already have their place in orthopaedic splint manufacture, for example in celluloid appliances of many kinds which are in everyday use. They are much lighter than plaster of Paris; they are unaffected by water and body secretions; and some are radiolucent. With the rapid development of modern plastics now taking place there is a wide field for research into their application in
1. Three new cases of injury to main arteries at orthopaedic operations are described, and a follow-up of two previously described cases is given. The rarity of these accidents is a credit to those engaged in
to determine the extent of Orthobullets use by orthopaedic residents in academic and clinical settings. We also wanted to determine whether its widespread use is the same in various training programs around the world and so we chose to survey two distinct programs without any academic or institutional ties. An electronic 9 question survey created using SurveyMonkey was sent to residents in two distinct Orthopaedic residency programs, either via text message or by email. The two programs surveyed were the McGill University
Calcium sulphate (CaSO. 4. ) is a recognised form of delivery of antibiotic for the treatment of bone infection. Complications inherent in the rapid reabsorption are well recognised (predominantly that of wound breakdown and leakage). There is little data on the frequency of these complications. The purpose of this study was to quantify the incidence of wound leakage from CaSO. 4. and the service impact in
In the welter of details contained in the preceding pages the reader has, I trust, perceived certain broad shining pathways leading towards our orthopaedic lode-star, the adequate treatment of all the crippled and disabled of our communityâadults and children, rich and poor. These are, as I see them, four in number: first, the emergence of our speciality from a tiny beginning, against the opposition of general surgery, to the position of an accepted branch of surgery secure in the support of all the branches of medical science. Second, the development not only of technical skill but of a humanitarian spirit which has resulted in the adequate care of the crippled child and, to a lesser degree, of the crippled adult. Third, the growth of educational facilities for undergraduate and postgraduate instruction and for research. Finally, the integration of
Although mechanical stabilisation has been a hallmark of orthopaedic surgical management, orthobiologics are now playing an increasing role. Platelet-rich plasma (PRP) is a volume of plasma fraction of autologous blood having platelet concentrations above baseline. The platelet α granules are rich in growth factors that play an essential role in tissue healing, such as transforming growth factor-β, vascular endothelial growth factor, and platelet-derived growth factor. PRP is used in various surgical fields to enhance bone and soft-tissue healing by placing supraphysiological concentrations of autologous platelets at the site of tissue damage. The easily obtainable PRP and its possible beneficial outcome hold promise for new regenerative treatment approaches. The aim of this literature review was to describe the bioactivities of PRP, to elucidate the different techniques for PRP preparation, to review animal and human studies, to evaluate the evidence regarding the use of PRP in trauma and
The aim of our survey was to study the current practice to manage DDH in UK by the members of the British Society for Children's
OP-1 is a bone morphogenetic protein which induces bone formation. For this reason, this protein is used to treat congenital pseudoarthrosis and post-traumatic non-union as well as to improve healing of bone grafting in
Purpose. Infections in
1. The amount of
While surgeon-industry relationships in orthopaedics have a critical role in advancing techniques and patient outcomes, they also present the potential for conflict of interest (COI) and increased risk of bias in surgical education. Consequently, robust processes of disclosure and mitigation of potential COI have been adopted across educational institutions, professional societies, and specialty journals. The past years have seen marked growth in the use of online video-based surgical education platforms that are commonly used by both trainees and practicing surgeons. However, it is unclear to what extent the same COI disclosure and mitigation principles are adhered to on these platforms. Thus, the purpose of the present study was to evaluate the frequency and adequacy of potential COI disclosure on orthopaedic online video-based educational platforms. We retrospectively reviewed videos from a single, publicly-accessible online peer-to-peer orthopaedic educational video platform (VuMedi) that is used as an educational resource by a large number of orthopaedic trainees across North America. The 25 highest-viewed videos were identified for each of 6 subspecialty areas (hip reconstruction, knee reconstruction, shoulder/elbow, foot and ankle, spine and sports). A standardized case report form was developed based on the COI disclosure guidelines of the American Academy of
A number of advantages of unicondylar arthroplasty (UKA) over total knee arthroplasty in patients presenting osteoarthritis in only a single compartment have been identified in the literature. However, accurate implant positioning and alignment targets, which have been shown to significantly affect outcomes, are routinely missed by conventional techniques. Computer Assisted
Aims: To assess whether there was a relationship between the timing of the first administration of fondaparinux and its efficacy and safety in preventing venous thromboembolism (VTE) in
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
Background and Aims. Many orthopaedic patients admitted to hospital who require urgent surgery are also on Warfarin. Patients with an INR>2 have an increased risk of bleeding complications during surgery; however delay to surgery due to a high INR has both clinical and financial implications. This audit evaluates whether the appropriate management for correction of INR is employed as per local guidelines and, if not, whether this results in significant delay to operative treatment. Methods. A retrospective and prospective audit was performed analysing all Orthopaedic trauma admissions admitted to University Hospital Aintree in a 5 month period. Only those solely on warfarin, who were not acutely bleeding and required surgery in <24 hours were included. Results. A sample of 17 patients was obtained of which only 35.3% had correct INR reversal as per local guidelines. Errors that occurred included 81.1% not being given further Vitamin K at reassessment, 18.2% given too much Vitamin K, 9.1% given too little Vitamin K, 18.2% given Octaplex incorrectly and 9.1% not given Octaplex when indicated. Only 1 patient had a delay to their surgery directly resulting from incorrect INR reversal (total time to surgery − 33 hours 45 minutes). Conclusion. Better education for clinical staff on the local policy for INR reversal in patients requiring urgent
Aim. The use of intraoperative cell salvage as a tool for reducing allogenic transfusion has been demonstrated in pelvic osteotomies. The aims of this audit were to identify any problems or complications with cell salvage, reduction in allogenic transfusion and identify procedures that would benefit. Methods. The use of cell salvage and allogenic transfusions were prospectively recorded over a 27-month period for all those who had major non spinal surgery looking at whether cell-salvage reduced allogenic transfusions and where cell salvage was used it was matched to procedure, diagnosis and age with cases where it was not used over the same time period. Results. Cell salvage was used in 61 cases. For these, average blood loss was 624mls and re-transfused volume 176mls (range=0-888mls). There were no complications. 4 problems occurred, 2 where suction became desterilised and 2 with insufficient sample to process. Of those that were matched, 3/55 cases required allogenic transfusion versus 11/55 that did not have cell salvage (p=0.03). Sub group analysis according to procedure did not reach significance. Excluding those with osteogenesis imperfecta, no isolated femoral osteotomy required allogenic transfusion (total number=48). Conclusion. Overall its use has reduced the number of children receiving allogenic blood and negates the need to cross match preoperatively. Group and save sample is probably sufficient for most major paediatric
Most children with spastic hemiplegia have high levels of function and independence but fixed deformities and gait abnormalities are common. The classification proposed by Winters et al is widely used to interpret hemiplegic gait patterns and plan intervention. However, this classification is based on sagittal kinematics and fails to consider important abnormalities in the transverse plane. Using three-dimensional gait analysis, we studied the incidence of transverse-plane deformity and gait abnormality in 17 children with group IV hemiplegia according to Winters et al before and after multilevel
Purpose: Operative site infections can have catastrophic consequences after
Purpose: Thromboembolic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE), are a serious risk after major
There is currently wide variation in the management of patients who are anticoagulated with Warfarin and require urgent
Three dimensional printing is an emerging new technology in medicine and the current educational value of 3D printed fracture models is unknown. The delayed surgery and need for CT imaging make calcaneal fractures an ideal scenario for preoperative 3D printed (3Dp) fracture models. The goal of this study is to assess if improvements in fracture understanding and surgical planning can be realized by trainees when they are given standard CT imaging and a 3Dp model compared to standard CT imaging and a virtual 3D rendering (3D CT). Ethics approval was granted for a selection of calcaneal fracture imaging studies to be collected through a practice audit of a senior orthopaedic trauma surgeon. 3Dp models were created in house. Digital Imaging and Communications in Medicine (DICOM) files of patient CT scans were obtained from local servers in an anonymized fashion. DICOM files were then converted to .STL models using the Mimics inPrint 2.0 (Materialise NV, Leuven, Belgium) software. Models were converted into a .gcode file through a slicer program (Simplify3D, Blue Ash, OH USA). The .gcode files were printed on a TEVO Little Monster Delta FDM printer (TEVO USA, CO USA) using 1.75mm polylactic acid (PLA) filament. Study participants rotated through 10 workstations viewing CT images and either a digital 3D volume rendering or 3Dp model of the fractured calcaneus. A questionnaire at each workstation assessed fracture classification, proposed method of treatment, confidence with fracture understanding and satisfaction with the accuracy of the 3Dp model or 3D volume rendering. Participants included current
Continuous neuraxial or deep peripheral nerve blockade used to provide postoperative analgesia after major
Background: Authors used a new bipolar sealer system (TissueLink Medical Inc., Dover, New Hampshire) for electrocoagulation in major
Introduction and Aims: Much of the world faces life without affordable health care. The burden of affordable specialist care has fallen, in large part, on visiting medical volunteers. However, culturally and resource-appropriate patient care is possible. Surgical specialties such as
Aims: Whether the use of elastic stockings (ES) on top of pharmacological thromboprophylaxis is beneficial remains debated. In a worldwide phase III program including 7344 patients in major
Surgical site infections (SSIs) are associated with significant consequences in
Cite this article:
Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems. A cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey.Aims
Methods
Integrated care pathways (ICPs) have been shown to have many benefits in clinical practice and are being widely adopted in
Aims. Computer hexapod assisted
There is mixed evidence in the literature regarding increasing age, ASA and BMI as risk factors for surgical site infection in
Robotic technology in adult reconstruction – initially the placement of the stem during THR – was introduced in the early nineties of last century, starting in the US. The underlying technology dated back to the year 1986. Because of regulatory restrictions the technology could not spread in the US, but was exported to Europe in 1994. There the technology – primarily distributed in Germany – had a great success and by the year 2000 roughly 50 centers were using Robodoc – the first robot on the market – and a very similar German competitor’s product, CASPAR. The initial robot was a crude machine, basically the unchanged beta version. Cumbersome fixation, a registration process using three fiducials, the requirement for second surgery to place the fiducials, and last but not least raw and hardly elaborated cutting files made surgery with Robodoc a demanding undertaking. Yet feedback from the surgeons, sometimes vigorously expressed during regular user meetings, let to continuous evolution of the system and resulted in an advanced and stable technology. Also training – with important input from the already experienced sites – improved significantly, which can best be demonstrated by procedure time for first surgery: in Frankfurt 1994 roughly four hours, while today first surgeries at new sites rarely exceed two hours. Further applications – revision surgery, total knee replacement – helped to justify the significant investment into the system. While robotic technology underwent evolution, other related technologies were developed and entered the market. Main products were the navigation systems, which initially were developed for neurosurgery and spine surgery and which, due to easier handling and lower costs, found more acceptance on behalf of the surgeons. Although the navigation technology in some regards is a step back from the robotic technology, it appealed for just that reason: the surgeon stays in the loop. The surgeon uses the traditional instruments, and the navigator helps him to achieve precision in reaming or placement of implants. In
Introduction: Thromboembolic complications are common in both elective and trauma orthopaedic practice. Despite the many studies reported in the literature, there remain a number of unanswered questions regarding the use of thrombophylaxis. The aim of this study was to establish the current practice amongst Irish consultant orthopaedic surgeons regarding thromboprophylaxis. Materials and Methods: A detailed confidential written questionaire was sent to all consultant orthopaedic surgeons in the republic of Ireland. Surgeons were asked to indicate the type of mechanical and chemothromboprophylaxis in the setting of total hip arthroplasty, knee arthroplasty and hip fracture. They were also questioned regarding 1) time of commencement of therapy 2) duration of therapy 3) method of diagnosis of DVT 4) Estimated incidence of mortality from pulmonary embolism in the last five years 5) Whether there was established protocol for DVT prophylaxis in their unit. 6) Reason for not using chemothromboprophylaxis if not used and 7) whether their method of treatment was influenced by anaesthetic concerns. Results: The response rate was seventy percent. Over ninetyfive percent of surgeons used a combination of physical and chemical modalities. There was a wide variation between type of therapy, commencement time and duration of prophylaxis. There was a higher rate of intervention and duration of therapy in elective practice. A unit policy regarding thromboprophylaxis existed in a majority of hospitals (54.7%). Forty-seven per cent of respondents felt that there had been no post-operative mortality in their practice in the previous five years from pulmonary embolism. Twenty-six percent of respondents felt that anaesthetists influenced the type of prophylaxis used. The results of this survey shows that venous thromboembolism is regarded as a significant complication of
Introduction: Radiation dose exposure to patients in a main X-ray department in a hospital is well documented and controlled. Few studies report the radiation exposure to patients undergoing spinal surgery received from an image intensifier. There are no recommended doses published when using the image intensifier. Methods: We reviewed the radiation doses and exposure times from computer and radiation log records of all the patients who underwent trauma &
Introduction: Fondaparinux, a selective inhibitor of activated factor X, has been shown to reduce further the risk of venous thromboembolism (VTE) in major
There has been a recent surge in the creation of medical student-led and foundation trainees-led research collaboratives in surgery. These have mainly been in general surgery. The current study therefore explores the value and feasibility of such collaboratives, highlighting the scope for a similar idea in orthopaedics. Research Collaborative organisations were systematically searched and reviewed to check whether medical students or junior doctors prior to speciality training led them. The advertised research projects and subsequent publication productivity for each identified organisation was also evaluated using the information presented on their websites. Two medical student-led research collaborative organisations and 1 medical student and foundation trainees-led research collaborative were identified. All of which are in general surgery and none in trauma and/or
In computer assisted
One of the advantages of Computer Assisted
Introduction. Surgical site infections (SSI) are related to a surgical procedure and affect the surgical wound or deeper tissues. With continuing emphasis on clinical governance and quality control, there is increasing demand from both patients and government for methods of assessing surgical results. Rates of morbidity and mortality may play important roles in these assessments. When crude comparisons between hospitals in the incidence of SSI are made, these should at least be stratified by the type of procedure. The aim of this study is to fix SSI incidence in relation to surgical procedure. Methods. This report contains data of 19.948 procedures collected from 1996 to 2008 at a Specialist Orthopaedic Hospital and analyzed by a specific software designed for the study of infection in orthopaedic and trauma surgery. The SSI surveillance is focused on categories of surgical procedure (Hip Arthroplasty, Knee Arthroplasty, Spine Surgery and Hip Fracture Surgery) with each category containing a defined set of similar procedures. A basic of demographic data and details about operation itself are collected for each procedure. Patients are followed up throughout their hospital stay and after hospital discharge. We present the incidence of SSI by risk group and surgical procedure. SSI are categorized in type, moment of diagnosis and micro-organisms reported. Analysis of the data was performed (SPSSv15.0 ®). Statistical methods used to determine significance were the independent samples t test, Pearson X2 test, Odds ratio and Spearman correlation coefficient, with a significance level of p<0,05. Results. Rates of SSI are highest in hip hemiarthroplasty after fracture and in hip and knee revision procedures. Rates of SSI increase with the number of risk factors present in the patient, especially after fracture procedures. The most common infecting micro-organism was coagulase-negative staphylococcus, followed by Staphylococcus aureus, enterococci and streptococci. 38% of the infections arise after one year of surveillance. Conclusions. Our results confirm difference in rates of SSI depending of surgical procedure in orthopaedic and trauma surgery. We believe that our decision to monitor infection with a long term follow up it's the better way to avoid under-reporting of infection. Our study has also demonstrated the extent to which the emerging problem of infection due to MRSA has affected
In modern
Background. Author credibility and creativity is often gauged by the number of scientific papers published, with the frequency of citations for particular articles reflecting the impact of published data on the area of practice. Aims. The objective of this study was to identify and analyse the qualities of the top one hundred cited articles in
Objectives. Indocyanine green (ICG) fluorescence angiography is an emerging technique that can provide detailed anatomical information during surgery. The purpose of this study is to determine whether ICG fluorescence angiography can be used to evaluate the blood flow of the rotator cuff tendon in the clinical setting. Methods. Twenty-six patients were evaluated from October 2016 to December 2017. The participants were categorized into three groups based on their diagnoses: the rotator cuff tear group; normal rotator cuff group; and adhesive capsulitis group. After establishing a posterior standard viewing portal, intravenous administration of ICG at 0.2 mg/kg body weight was performed, and fluorescence images were recorded. The time from injection of the drug to the beginning of enhancement of the observed area was measured. The hypovascular area in the rotator cuff was evaluated, and the ratio of the hypovascular area to the anterolateral area of the rotator cuff tendon was calculated (hypovascular area ratio). Results. ICG fluorescence angiography allowed for visualization of blood flow in the rotator cuff in all groups. The adhesive capsulitis group showed significantly earlier enhancement than the other groups. Furthermore, the adhesive capsulitis group had a significantly smaller hypovascular area ratio than the other groups. Conclusion. ICG fluorescence angiography allowed for evaluation of real-time blood flow of the rotator cuff in arthroscopic shoulder surgery. The techniques of ICG fluorescence angiography are simple and easy to observe, observer reliability is high, and it has utility for evaluating blood flow during surgery. Cite this article: N. Doi, T. Izaki, S. Miyake, T. Shibata, T. Ishimatsu, Y. Shibata, T. Yamamoto. Intraoperative evaluation of blood flow for soft tissues in
This paper describes an audit loop. We studied patients undergoing hip and knee surgery (arthroplasty and revision arthroplasty). All the patients were ‘complex elective’. I.e. they were either ASA grade 3 or 4, or had a body mass index in excess of 40. We collected data concerning postoperative admissions to HDU, ICU and PACU (planned and unplanned rates of admission, length of stay). We also noted mortality. In the first part of the study (April 2005 to March 2006) we studied 298 patients. All patients were assessed independently by an anaesthetist on the day of surgery. A multidisciplinary preoperative assessment clinic commenced in April 2006. After this date all patients were assessed preoperatively by a multidisciplinary anaesthetic lead team (anaesthetist, orthopaedic senior house officer, nurse practitioner). The need for an HDU or ICU bed was assessed and the bed was booked at part of the pre-operative plan. In the second part of the study (May 2006 to April 2009) a further 1147 arthroplasty patients were studied. Data was again collected regarding HDU, ICU, PACU and mortality as noted above. We found statistically significant (p=0.001) reductions in the admissions to PACU (22% down to 10%) and in mortality (6.1% down to 1.2%) after the introduction of the pre assessment clinic. There was also statistically significant (p=0.01) reduction in the HDU length of stay(2.1 days to 1.6 days), ITU unplanned admissions (1.3% to 0.4%) and the ITU length of stay in days (2.3 to 1.9 days). We also estimated cost savings of nearly £50 000 in the second limb of the study. This is based on the average decrease in HDU and ICU length of stay. We recommend the use of a multidisciplinary pre assessment clinic for complex
Purpose of the study: Prevention of operative site infections (OSI) in
Wireless technologies applied to the medical field have grown both in prevalence and importance in the past decade. Various applications and technologies exist underneath the telemedicine umbrella including Point-of-Care systems where electrocardiographs, blood pressure, temperature, and medical image data are recorded and transmitted wirelessly, which enables remote patient monitoring from inside hospitals, personal residences, and virtually any location with access to satellite communication. Another widespread application for wireless systems in hospitals is asset tracking, typically done with RFID technology. Wireless technologies have not been widely used in computer assisted