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Bone & Joint Open
Vol. 2, Issue 10 | Pages 825 - 833
8 Oct 2021
Dailey HL Schwarzenberg P Webb, III EB Boran SAM Guerin S Harty JA

Aims

The study objective was to prospectively assess clinical outcomes for a pilot cohort of tibial shaft fractures treated with a new tibial nailing system that produces controlled axial interfragmentary micromotion. The hypothesis was that axial micromotion enhances fracture healing compared to static interlocking.

Methods

Patients were treated in a single level I trauma centre over a 2.5-year period. Group allocation was not randomized; both the micromotion nail and standard-of-care static locking nails (control group) were commercially available and selected at the discretion of the treating surgeons. Injury risk levels were quantified using the Nonunion Risk Determination (NURD) score. Radiological healing was assessed until 24 weeks or clinical union. Low-dose CT scans were acquired at 12 weeks and virtual mechanical testing was performed to objectively assess structural bone healing.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 36 - 36
1 Feb 2014
Matthews J Hall A Lonsdale C Hernon M Murray A Taylor I Jackson B Toner J Guerin S Hurley DA
Full Access

Purpose of the study and background

The CONNECT trial evaluated a theory-based intervention to increase low back pain patients' adherence to treatment recommendations through physiotherapists' communication behaviour. Bridging the gap between evidence and evidence-based practice, we aimed to develop an implementation intervention to support physiotherapists in translating the CONNECT communication training into practice.

Methods and results

A systematic approach was used to develop this intervention. 1. Focus groups underpinned by the Theoretical Domains Framework were conducted to assess CONNECT trained physiotherapists' (n = 9) perceptions of the barriers and enablers to implementing these strategies in practice; the results of which yielded four main domains; two related to factors outside the individual (i.e. social influences and environmental resources), and two related to individuals' motivation and capabilities (i.e. self –efficacy and behavioural regulation). 2. Intervention components (i.e., behavior change techniques (BCT) and mode of delivery) were chosen. BCTs were mapped to the identified domains (e.g., the BCT of self-monitoring mapped to the self-efficacy domain) and audit and feedback focused coaching was selected as the main mode of delivery based on empirical evidence and feasibility. 3. Outcome measures were selected to evaluate the proposed changes in physiotherapist practice (i.e., Health Care Climate Questionnaire). This intervention was trialed with physiotherapists (n = 2) using a case-study design. Results from patient consultation audio-recordings and follow-up interviews revealed this intervention supported the translation of evidence-based training into practice and is considered feasible and acceptable to physiotherapists.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 27 - 27
1 Sep 2012
Cove R Guerin S Stephens M
Full Access

Method

A questionnaire was given to delegates at the British Orthopaedic Foot & Ankle Society (BOFAS) annual scientific meeting 3rd–5th November 2010. A total of 75 questionnaires were included within the analysis. The questionnaire asked delegates for their most commonly performed procedure for a variety of common foot and ankle conditions.

Results

Which procedure do you most commonly perform?

Hallux valgus mild; Chevron 60.0%
Scarf 28.0%.
Hallux Valgus Moderate; Scarf 85.3%
Chevron 12.0%
Hallux Valgus Severe; Scarf 65.3%
Basal Osteotomy 29.3%
1st MTPJ OA Fusion; crossed screws 54.7%
Plate 26.7%
Lesser toe Metatarsalgia; Weil 48.6%
BRT 22.8%
Hammer second toe; PIPJ Fusion 62.7%
Oxford Procedure 15%
Tib Post stage 1; Debridement 60.0%
Conservative 24.0%
Tib Post stage 2; FDL Transfer 76.0%
Calc. osteotomy 78.7%
Achilles tendon rupture Open Repair 61.5%
Percutaneous 13.8%

In delegates' normal practice they would fuse an osteoarthritic ankle 90% and perform a Total Ankle replacement 10% of the time. The method of fusion is split 50/50 between arthroscopic and open. Regarding the anaesthetic used for forefoot surgery most are using GA + Regional Block (mean 60%) only occasionally using regional anaesthesia alone (mean 8%)

Only 12.3% of delegates have tried minimally invasive [forefoot] surgery (MIS), 17.3% of delegates think they will do more MIS in the future.

The practice of British orthopaedic foot and ankle surgeons is broadly in line with an evidence-based approach. Knowledge of current practice may help trainees make sense of the myriad foot and ankle operations described in the literature.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 261 - 261
1 Sep 2012
Crockett M Guerin S McElwain J
Full Access

Background

Smartphones are now a ubiquitous presence within the modern healthcare setting. Uses such as internet, database software and storage of medical textbooks, all contribute to the clinical value of the devices. Within orthopaedics, transmission of digital images via smartphones is now routinely used to obtain instant second opinions of trauma radiographs. However questions remain as to whether smartphone image quality is sufficient for primary diagnosis and secondary consultation

Aim

To assess the accuracy of diagnosis made when radiographs are viewed on a smartphone screen in comparison with a standard digital monitor. Also to assess the diagnostic confidence, diagnostic difficulty, subjective image quality and formulation of management plan.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 180 - 180
1 Mar 2006
Guerin S
Full Access

Introduction: Several studies have established a relationship between the preoperative haemoglobin level and the need for postoperative blood transfusion. The aim of this study was to identify clinical factors associated with the need for perioperative blood transfusion in non-anaemic patients undergoing hip or knee arthroplasty.

Methods: We prospectively evaluated 162 consecutive patients who underwent total hip or knee arthroplasty in the period between January 2001 and April 2001 in our centres. A univariate analysis was performed to establish the relationship between all independent variables and the need for postoperative transfusion, with significant variables being included in a multivariate analysis.

Results: Univariate analysis revealed a significant relationship between the need for postoperative blood transfusion and preoperative haemoglobin levels (p=0.001), weight (p=0.019), and age (p=0.018). Multivariate analysis identified a significant relationship only between the need for transfusion and the preoperative haemoglobin level (p=0.0001). Patients with a preoperative haemoglobin level of < 13g/dl had a 1.5 times greater risk of having a transfusion than did those with a haemoglobin level of 13–15g/dl and a 4 times greater risk of having a transfusion than did those with a haemoglobin level > 15 g/dl.

Conclusion: The preoperative haemoglobin level of the patient was the only variable to independently predict the need for blood transfusion after arthroplasty. Patients with a haemoglobin level < 13.0g/dl were 4 times more likely to have a transfusion than those with a haemoglobin level > 15g/dl.