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Bone & Joint Open
Vol. 3, Issue 12 | Pages 953 - 959
23 Dec 2022
Raval P See A Singh HP

Aims

Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK.

Methods

A multicentre retrospective cohort collaborative study was conducted. All patients over the age of 18 with an isolated DTC fracture in 2019 were included. Demographic variables were recorded: age; sex; side of injury; mechanism of injury; modified Neer classification grading; operative technique; fracture union; complications; and subsequent procedures. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_1 | Pages 6 - 6
1 Jan 2022
Raval P See A Singh H Collaborative D
Full Access

Abstract

Background

Distal third clavicle (DTC) fractures represent 2.6 to 4% of all adult fractures but there is no consensus as to the surgical management of these injuries. The primary outcomes of this study were to determine the frequency of DTC fractures and their management. Secondary outcomes included complications, further procedures, fracture union and the breakdown of treatment by modified Neer classification.

Methods

A multicentre cohort study was conducted between 1st January 2019–31st December 2019. All patients, over 18 years old, with an isolated DTC fracture were included. Demographic variables, management, mechanism of injury, modified Neer classification and fracture union were recorded. Simple statistical analysis was performed as a total dataset and as a breakdown of major trauma centres (MTCs) vs trauma units (TUs).


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_3 | Pages 15 - 15
1 Apr 2019
Gibbs VN Raval P Rambani R
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Background of study

There has been an exponential increase in the use of direct thrombin (DT) and factor Xa inhibitors (FXI) in patients with cardiovascular problems. Premature cessation of DT/FXI in patients with cardiac conditions can increase the risk of coronary events. Our aim was to ascertain whether it is necessary to stop DT and FXI preoperatively to avoid postoperative complications following hip fracture surgery.

Materials and Methods

Prospective data was collected from 189 patients with ongoing DT/FXI therapy and patients not on DT/FXI who underwent hip fracture surgery. Statistical comparison on pre- and postoperative haemoglobin (Hb), ASA grades, comorbidities, operative times, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rates between the two groups was undertaken.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_8 | Pages 74 - 74
1 Apr 2017
Raval P Ogollah R Hall A Foster N Roddy E
Full Access

Introduction

Subacromial corticosteroid injection is widely used in the treatment of Subacromial Impingement Syndrome (SIS). There is increasing interest in using ultrasound (US) to improve the accurate placement of injections. This study investigated whether the accuracy of placement of US-guided subacromial corticosteroid injections influences patients' outcome of pain and function.

Method

Secondary analysis of data from a 2−2 factorial randomised controlled trial investigating exercise and corticosteroid injection for pain and function in SIS. US-guided injections were delivered according to a pre-defined protocol. Video images were reviewed to categorise accuracy of injection into the subacromial bursa into 3 accuracy groups using pre-defined criteria: 1) not in the subacromial bursa; 2) probably in the subacromial bursa; and 3) definitely in the subacromial bursa. The primary outcome measure was the self-reported Shoulder Pain and Disability Index (SPADI) total score, compared at 6 weeks and 6 months. Secondary outcomes included SPADI pain and function subscales and participant global rating of overall change from baseline. A mixed effects model was used to compare accuracy groups' outcomes at 6 weeks and 6 months, adjusted for baseline covariates.