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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 49 - 49
24 Nov 2023
Azamgarhi T Perez-Sanchez C Warren S Scobie A Karunaharan N Houghton R Hassan S Kershaw H Sendi P Saeed K
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Aim

Dalbavancin is a lipoglycopeptide with a half-life of 14 days (range 6.1 to 18.4), significantly longer than other antimicrobials, which avoids the need for daily antibiotic dosing. This multi-centre observational study aims to describe the use of dalbavancin to facilitate discharge in treating bone and joint infections.

Method

All adult patients treated with dalbavancin from January 2017 to September 2022 in four UK bone infection units were included.

Data collected through a standardised data collection form included:

Clinical and microbiological characteristics.

Hospital length of stay.

Complications.

Patient suitability for hypothetical treatment options, such as Outpatient Parenteral

Antibiotic Team (OPAT)

Clinical outcome.

Treatment-related costs were calculated for dalbavancin and the preferred hypothetical treatment option that would have been administered for the same duration. The costs were subtracted to calculate the cost difference.

Clinical success was defined as the absence of definite failure in accordance with the OVIVA Trial protocol.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_7 | Pages 127 - 127
4 Apr 2023
Sankar S Antonik M Hassan S
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The e-scooter trial was part of a wider initiative from the Department for Transport in response to COVID pandemic. New emergency legislation was introduced in 2020 to make e-scooters legal in the UK for the first time. This scheme was launched in our county from September 2020. The aim of this case series was to identify the types of Orthopedic injuries resultant from electric scooter transport that presented to our District General Hospital over a 16-month period between September 2020 and December 2021.

This study involved retrospective collection of data from electronic hospital records. Data on demographics, laterality, date of injury, type of injury, treatment, HDU/ITU admissions, mortality, and operating time were collected to characterize the types of e-scooter-related injuries and to investigate the frequency of such injuries over the duration of our search.

A total of 79 orthopedic patients identified with electric scooter injuries between September 2020 and December 2021. 78.5% were males and the mean age was 30.1 years. Summer months accounted for most of the injuries. 17 patients required inpatient care. 23 patients required surgical intervention and a total of 29 surgeries were performed in our hospital. This accounted for a total surgical time of 2088 minutes. One patient admitted with shaft of femur fracture developed pulmonary embolism after the definitive operation and died in HDU.

Electric scooters provide a space efficient, affordable, environmentally friendly mode of transportation which reduce the urban congestion and parking issues. This study demonstrates an increasing frequency of significant orthopedic injury associated with e-scooter use treated at our centre over the course of 16 months. This small series underlines an important problem given that this increase has occurred after the start of the electric scooter trial. Legalization might result in further increase in the incidence of injury.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_23 | Pages 14 - 14
1 May 2013
Hassan S Salar O Lau K Espag M Cresswell T Clark DI
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Purpose

Assess and report the functional and post-operative outcomes of complex acute radial head fractures with elbow instability treated by arthroplasty using an uncemented modular anatomic prosthesis.

Methods

Over a 3-year period (2007–2010), 21 patients (mean age 51.9 years) were treated primarily with modular radial head arthroplasty (mean follow up of 27.1 months). Data was collected retrospectively using clinical notes, operation documentation and prospectively using validated scoring systems namely the Oxford Elbow Index, Quick DASH and the Mayo Elbow Performance Score. Associated elbow fractures, ligamentous injury and short to mid term post-operative outcomes including radiographic assessment were recorded.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 117 - 117
1 Jan 2013
Hassan S Gale J Perks A Raurell A Ashford R
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We reviewed 100 consecutive primary sarcoma patients identified from coding records from January 2009 to April 2011. A computerised system was used to access theatre records, and operative details were checked against patient notes to ensure accuracy. Data on demographics, pathology, surgical and oncological management was collected.

Of the 100 patients reviewed, 52 were male and 48 female with an average age of 64.9 years (range 23–102 years). Of the 100 operations performed, 13 had primary reconstruction with a myocutanoeus flap, of which 9 varieties were used. Twenty-five patients had reconstruction with a split or full thickness skin graft and 9 patients had a limb amputation. Length of inpatient stay ranged from 0 to 63 days and was greatest for our amputee's. Mean operative time did not increase significantly with rise in case complexity. 31 of our patients received post-operative radiotherapy, one patient had induction radiotherapy whilst another had induction chemotherapy.

5 out of the 100 patients underwent re-excision due to incomplete margins being obtained at primary wide local excisions. We had one patient with a failed free latissimus dorsi flap, in which secondary reconstruction with pedicled gastrocnemius and skin grafting was successful. One patient had a scalp flap following a re-excision of a positive margin of an angiosarcoma.

Using a combined oncological orthopaedic and reconstructive plastic surgery approach, in our centre 38% of patients require some form of soft tissue reconstruction following tumour resection, with 13% of all patients requiring microvascular flap reconstruction. We have a 9% amputation rate, which is comparable with other published series.

Reconstruction following soft tissue sarcoma is complex and highly demanding, the challenges being best met by a combined orthoplastic surgical team.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 505 - 505
1 Sep 2012
Wall A Wall A Hassan S Charalambous C
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Approximately 30000 total knee replacements are performed annually in the UK. Standard practice is to obtain a radiograph during the initial post-operative period. We performed a retrospective review of 638 total knee replacements and found no significant complications were visible on post-operative radiographs. There were 4 cases of mild femoral notching. Cessation of initial radiographs could save the NHS two million pounds annually. We suggest check radiographs in the initial post-operative period are unnecessary and waste valuable resources which could be distributed elsewhere.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 6 - 6
1 Jul 2012
Hassan S Swamy GN Malhotra R Badhe NP
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PURPOSE OF STUDY

Periprosthetic fractures after total knee arthroplasty is a potentially serious and challenging complication and the incidence is continuously rising. The purpose of this study was to analyse the prevalence and analyse effectiveness of the various treatment methods for management of periprosthetic fracture of the distal femur after total knee arthroplasty, and to determine the clinical and radiographic results of patients following surgical treatment of these injuries.

METHODS

We reviewed all patients with periprosthetic fractures after total knee arthroplasty treated surgically between 2003 and 2008 from the prospective hospital database. Medical and radiographic records were reviewed for patient characteristics, fracture characteristics, implant details, healing, and complications.

Antero-posterior and lateral radiographs were reviewed at the time of admission, post-operatively and at follow up visits. Fractures were classified according to the Lewis and Rorabeck, Orthopaedic Trauma Association and the methods of Su and DeWal.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 55 - 55
1 Apr 2012
Lakshmanan P Hassan S Quah C Collins I
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We described a technique of measuring the flexibility of the rib prominence clinically before surgery, and aimed to analyse the results in patients with adolescent idiopathic scoliosis who underwent posterior correction with pedicle screw instrumentation.

This prospective study investigated the magnitude of rib humps before and after the operation when the patient was in Adam's forward bending posture. Also preoperatively, a flexion and derotation manoeuvre was performed and the corrected rib prominence was measured. This is compared to the magnitude of the rib hump present postoperatively at three months' follow up.

Seven consecutive patients with adolescent idiopathic scoliosis that underwent posterior surgical correction.

Clinical measurement of rib prominence using scoliometer.

The magnitude of the curve improved from a mean preoperative Cobb angle of 53.6+/−11.2° (range 45.3–72.5°) to a mean postoperative Cobb angle of 7.8+/−9.3° (range 0.4–17.6°). The mean preoperative magnitude of the rib hump was 12.3+/−6.9° (range 5-20°) which was then corrected to a mean magnitude of 1.3+/−2.2° (range 0-5°) by performing the above described flexion derotation manoeuvre. The mean postoperative magnitude of the rib hump was 3.0+/−3.1° (range 0-8°) with the patient in Adam's forward bend position. There was positive correlation between the postoperative residual rib hump and the reduced rib hump measured preoperatively using our described technique (r=0.8,p=0.05).

This flexion derotation test is a useful in assessing the amount of postoperative persistent rib hump after posterior correction of adolescent idiopathic scoliosis using pedicle screw instrumentation with derotation technique.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 7 - 7
1 Mar 2012
Bhutta MA Arshad MS Hassan S Henderson JJ
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A 5 year review of factors instigating malpractice claims and likely to result in a payout. Possible lessons for the future.

Background

During 2002-2007 over 300,000 patients underwent knee arthroplasty (KA) in England and Wales, from which 204 cases of litigation were processed costing in excess of £5million. The complications associated with primary KA are well documented, however those instigating litigation in the UK are not known.

This study assessed trends in litigation over the past 5 years identifying instigating factors and success rates to highlight areas for further improvement in patient information and surgical management.

Methods

Data from the NHS Litigation Authority on claims following KA unrelated to trauma between 2002 and 2007 were obtained and analysed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_II | Pages 49 - 49
1 Feb 2012
Geoghegan J Hassan S Calthorpe D
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It is widely recognised that pelvic disruption in association with high-energy trauma is a life-threatening injury. The potential morbidity and mortality associated with acetabular injuries are less well understood. Due to chronic underfunding and the absence of a comprehensive and coordinated national approach to the management of acetabular trauma throughout the UK, patients can incur prolonged recumbency. Prompt and appropriate referral for specialist management, thromboprophylaxis and venous thrombosis surveillance are important issues for the referring centre. We performed a postal questionnaire to establish the current clinical practice in the specialist centres throughout the UK in pelvic and acetabular trauma, with respect to time to surgery, thromboprophylaxis, and surveillance.

We identified twenty-one units and thirty-seven surgeons in the NHS who deal with pelvic and acetabular injuries. The mean time to surgery from injury in the UK is 8.5 days (range 2-19 days). The larger units that accept and treat patients from outside their region experience the greatest delay to surgery. Mechanical thromboprophylaxis was used in 67% (14) of the units. 24% (5) use arterio-venous boots, 19% (4) use calf pumps, and 52% (11) use TEDS stockings. No unit routinely use prophylactic IVC filters in acetabular trauma. Chemical thromboprophylaxis is routinely used in 100% (21) of the units. 95% (20) used prophylactic doses of unfractionated heparin or low molecular weight heparin. Clinical surveillance alone for thromboembolism is employed in 90% (19) of the units. Only 2 (10%) units routinely perform radiological surveillance with ultrasound Doppler on its acetabular fracture cases pre-operatively.

Currently there is no published directory of dedicated pelvic and acetabular surgeons in the UK. There is no general consensus on the approach to thromboprophylaxis and surveillance in acetabular trauma in the UK. There is no consensus approach to thromboprophylaxis and surveillance in the literature.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 11 - 11
1 Mar 2008
Hassan S Lewis J Moran C Wenn R
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To assess the relationship between preoperative urea concentration and mortality in patients with hip fractures requiring surgery, we carried out a prospective observational study of 1230 consecutive patients admitted to a single trauma unit with a hip fracture, required surgery.

Results: The mean age was 80 years (range 17–101) and 931 (77%) were female. 669 patients (54%) had intracapsular fractures, 547 patients (45%) had extra-capsular fractures and 14 patients (1%) had periprosthetic fractures. 760 (62%) patients were admitted from their own homes, 178 (15%) from residential homes, 150 (12%) from nursing homes and 123 (10%) from warden-aided homes. 644 (53%) were independently mobile before injury, 311 (26%) used walking aids, 241 (20%) were mobile with the use of a frame and 24 (2%) were unable to walk. 371 (32%) patients had a mini mental test score of less than 7. 49 (4%) were known to have renal disease and 106 (9%) had diabetes.

The 30-day mortality was 9.8% and the 90-day mortality was 19.9%. The mortality at 1 year was 29.0% and at 2 years was 30.2%. There is a clear relationship between a raised admission urea concentration and mortality at 90 days, 1 year and 2 years. Abnormalities of serum sodium and potassium concentration did not influence mortality.

Conclusion: Mortality is high following hip fracture. Patients admitted with a raised serum urea and treated with operative methods are at increased risk of death at all the time intervals analysed, up to and including 2 years. This group of patients may require a separate care pathway that provides more intensive management of fluid and electrolyte balance.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 340 - 340
1 Nov 2002
Harty JA Quinlan JF Soffe KE Hassan S Walsh MG Byrne JO
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Objective: To date the principal focus of the mechanism of cervical spine fracture has been directed at head/ neck circumference and spinal canal dimensions. However the role of other measurements, including chest diameter and head/neck/chest proportional ratios, in a standard cervical fracture population has not yet been studied in detail. Cervical fractures often involve flexion/ extension type mechanisms of injury, with the head and cervical spine flexing/extending, using the thorax as a fulcrum.

Study design: We prospectively studied all patients with cervical spine fractures who were admitted to the spinal injuries unit from 1st July, 2000 to 1st March 2001. Anthropometrical measurement of head circumference, neck circumference, chest circumference, and neck length were analysed. Ages ranged from 18 – 55yrs, and all patients with concomitant cervical pathology were excluded from the study. Mechanism of injury involved flexion/extension type injuries in all cases; those with direct axial loading were excluded. A control group of 30 patients (age 18–55yrs) involved in high velocity trauma with associated long bone fractures, in whom cervical injury was suspected but without any cervical fracture, or associated pathology, were measured.

Results: Our analysis revealed a statistically significant increase in chest size in the male control group versus the fracture group 98.89cm v. 94.19cm (P< 0.05, t-test). There was a correspondingly significant increase in chest circumference between the female control versus the fracture group 94.33cm v. 88.88cm(P< 0.05, t-test). Our results revealed no statistical difference in either head circumference, neck circumference, or neck length between each of the groupings. However we found a statistically significant increase in head/neck/chest ratios between each of the groups. These results indicate a proportionately larger chest may be protective in cervical spine fractures.