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
Aims. The use of 3D printing has become increasingly popular and has been widely used in
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
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
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. 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
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
Aims: Aim of this study is to review the role of biomechanical modelling in computer aided
Among the advanced technology developed and tested for
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
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
The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O). Data collected by the UK Medical Education Database (UKMED) between 1 January 2014 and 31 December 2019 were used in this retrospective longitudinal cohort study comprising 1,960 CSTs eligible for ST3. The primary outcome measures were whether CSTs applied for a T&O ST3 post and if they were subsequently offered a post. A directed acyclic graph was used for detecting confounders and adjusting logistic regression models to calculate odds ratios (ORs), which assessed the association between the primary outcomes and relevant exposures of interest, including: age, sex, ethnicity, parental socioeconomic status (SES), domiciliary status, category of medical school, Situational Judgement Test (SJT) scores at medical school, and success in postgraduate examinations. This study followed STROBE guidelines.Aims
Methods
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