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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_8 | Pages 43 - 43
1 May 2018
Taylor JM Ali F Chytas A Morakis E Majid I
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Introduction

This study reviews the orthopaedic care of the thirteen patients who were admitted and treated at Royal Manchester Children's' Hospital following the Manchester Arena Bomb blast

Methods

We included all children admitted to Royal Manchester Children's Hospital injured following the bomb blast who either suffered upper limb, lower limb or pelvic fractures, or penetrating upper or lower limb wounds. The nature of each patient's bone and soft tissue injuries, initial and definitive management, and outcome were assessed and documented. Main outcome measures were time to fracture union, time to definitive soft tissue/skin healing, and functional outcome.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_8 | Pages 45 - 45
1 May 2018
Jahangir N Umar M Rajkumar T Davis N Alshryda S Majid I
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Purpose of study

To review the treatment and outcomes of paediatric pelvic ring injuries in the UK

Methods and results

We performed a retrospective review of all pelvic fracture admissions to an English paediatric major trauma centre (MTC) from 2012 to 2016. A total of 29 patients were admitted with pelvic ring injuries with a mean age of 11 years (4- 16yrs). Road traffic accident was the mechanism in majority (72%), followed by fall from height (24%). Femoral shaft fracture was present in 5 (17%), head injury in 5 (17%), chest injuries in 5 (17%) and bladder injury in one child. 48% patients needed surgical procedures for fractures or associated injuries. We differentiated injuries according to the classification system of Torode and Zeig. 17% were Type A, 3% Type B, 48% Type C and 31% Type D. Almost all (93%) patients were treated conservatively. 51% of patients were allowed to mobilize full weight bearing after a period of bed rest. Non-weight bearing mobilization was recommended for fractures extending into the acetabulum, sacral fractures, unstable fracture patterns or associated fractures (neck of femur, femoral shaft and tibial shaft). Surgical fixation occurred in two patients. Both of these patients had significantly displaced Type D fractures. Only 44% of patients were back to sports at six months.


The Bone & Joint Journal
Vol. 100-B, Issue 1 | Pages 109 - 118
1 Jan 2018
Talbot C Davis N Majid I Young M Bouamra O Lecky FE Jones S

Aims

The aim of this study was to describe the epidemiology of closed isolated fractures of the femoral shaft in children, and to compare the treatment and length of stay (LOS) between major trauma centres (MTCs) and trauma units (TUs) in England.

Patients and Methods

National data were obtained from the Trauma and Audit Research Network for all isolated, closed fractures of the femoral shaft in children from birth to 15 years of age, between 2012 and 2015. Age, gender, the season in which the fracture occurred, non-accidental injury, the mechanism of injury, hospital trauma status, LOS and type of treatment were recorded.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_13 | Pages 6 - 6
1 Jun 2017
Haughton D Ali F Majid I
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To analyse the management of open paediatric tibial fractures treated at a children's Major Trauma Centre (MTC), comparing fixation methods, union and complications.

We retrospectively identified all patients admitted to RMCH with an open tibia fracture between 2008 – 2016. Demographics, mechanism, inpatient stay and follow-up management were reviewed. There were a total of 44 patients, with an average age = 10 years (3–15). 93% of cases were caused by road traffic accidents, commonly pedestrian versus car. Older children were more likely to sustain higher grade injuries, requiring increased length of stay. 35 patients had primary / delayed wound closure, 1 patient required fasciotomies and 4/44 needed skin grafts and/or flap. 7 patients were treated in plaster, 9 by elastic nailing, 15 had mono-lateral fixators and 12 with circular frame. The average number of surgeries = 3 (1–7) with older children having increased risk of revision surgery. Monolateral fixators were the most common primary fixation method (n=15), however 60% required revision to ring fixator due to displacement or delayed union. The main risk factor for displacement was inadequate fracture reduction in theatre, as well as those fracture patterns involving butterfly fragments. Union (defined as RUST score = 3 on >3 cortices) was achieved in all patients (ave 6 months). Delayed union was associated with higher grade injuries, those treated with elastic nails demonstrated the longest union time (ave 7.3 months). 21/44 (47.7%) patients had complications, with pin site infection being the most commonly seen. 18% patients suffered a major complications needing further surgery.

Various fixation methods can be successfully used to treat these fractures. They demonstrate a high complication rate and often require multiple surgeries, with union taking an average of 6 months. Mono-lateral fixators demonstrate a high revision rate, particularly if the fracture is not well reduced.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 85 - 85
1 Jul 2012
Jain R Majid I Liu A Jones R Johnson D
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Aim

To determine the tensile forces across the knee extensor mechanism during walking, in simulated conditions of treatment.

Methods

Gait analysis of six normal subjects was performed, with full weight bearing unilateral immobilisation of the knee during walking. Measurements were taken without then with a brace, unlocked then locked at 0°, 0-10°, 0-20° and 0-30° of flexion. Mean and maximum knee flexion angles were measured, followed by calculation of the mean and maximum forces across the extensor mechanism during loading, supporting and propulsion phases of gait.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 13 - 14
1 Mar 2009
Majid I Ibrahim T Clarke M Kershaw C
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Aims: To investigate the effect of age and occupation on the outcome of carpal tunnel decompression.

Patients and Methods: A total of 271 patients undergoing primary carpal tunnel decompression by a single surgeon were studied. Patients with inflammatory joint disease, thyroid disease and diabetes mellitus were excluded. Outcome was assessed using the Levine-Katz carpal tunnel questionnaire at two weeks preoperatively and six months postoperatively. Cases were divided into six age groups (less than 40 years of age, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and over 80 years of age) and 12 occupational groups according to the International Standard Classification of Occupations (ISCO-88). Statistical analysis was performed using one-way analysis of variance (ANOVA) and post ad-hoc analyses.

Results: Overall there was an improvement in total Levine scores in 269 (99.3%) patients (mean change 33.1, 95%CI: 31.5 to 34.7). This change was greatest in those over 80 years of age (mean 35.8, 95%CI: 29.0 to 42.6) and in those who were service or sales workers (mean 39.6, 95%CI: 34.9 to 44.2), and least in the 70–79 age group (mean 30.7, 95%CI 25.7 to 35.8) and craft and trade workers (mean 29.8, 95%CI: 21.8 to 37.9). Patients reported a greater improvement in symptoms (mean score change 21.4, 95%CI: 20.2 to 22.2), than function (mean 12, 95%CI: 11.1 to 12.7). We found no significant difference in the total, functional or symptomatic Levine score changes between the six age groups (p=0.05) and the 12 occupation groups (p=0.05) following carpal tunnel decompression.

Conclusion: Almost all patients improved after carpal tunnel decompression. However, we found no influence of age and occupation on the outcome of carpal tunnel decompression in our series of patients.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 104 - 104
1 Mar 2009
Majid I Rahbi H Ibrahim T Slibi M
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Aim: To evaluate the morbidity and mortality in the perioperative period of patients with aortic stenosis following fractures of the proximal femur.

Patients and Methods: A retrospective review was undertaken of medical notes of all patients (n=20) admitted to our trauma unit over an 18 month period with fractures of the proximal femur and concomitant aortic stenosis confirmed by transthoracic echocardiography. Assessment was made of perioperative factors thought to be important in influencing outcomes in such patients as highlighted in the 2001 Report of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) “Changing the way we operate”. These included previous history of angina or ischaemic heart disease, preoperative optimisation by an anaesthetist or physician, maximum pressure gradient across the aortic valve and ventricular ejection fraction on transthoracic echocardiography, seniority of anaesthetist and surgeon performing the procedure, intraoperative invasive monitoring, postoperative high dependency care and complications and outcomes.

Results: Prior to surgery three patients (15%) were seen by a physician and nine patients (45%) by an anaesthetist for medical optimisation. The mean maximum pressure gradient across the aortic valve on transthoracic echocardiography was 38.6 mmHg (range: 12 to 111 mmHg), and five patients (25%) were confirmed as having severe aortic stenosis. Anaesthesia was performed by consultant anaesthetists in 85% of cases with the remaining 15% carried out by trainees. No patients had intraoperative central venous pressure (CVP) monitoring, and only three of the 20 (15%) patients had intra-arterial blood pressure (IABP) monitoring. Only two patients spent one day in the High Dependency Unit postoperatively. The remainder of the patients were discharged back to the general ward where the mean length of stay was 28 days (range: 0 to 135). Postoperatively two patients (10%) developed arrhythmias, three (15%) experienced an episode of acute left ventricular failure and four (20%) developed hypotension. There were two deaths (10%).

Conclusion: It is evident that patients with proximal femoral fracture and concomitant aortic stenosis are still not benefiting from the recommendations of the NCEPOD report in the perioperative period. The authors suggest the introduction of a dedicated multidisciplinary team for the management of patients with proximal femoral fractures and concomitant aortic stenosis.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 66 - 66
1 Mar 2009
Mahmood A Zafar M Majid I Maffulli N
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Objectives: Minimally invasive hip arthroplasty (MIHA) has become a trend in last few years. The orthopaedic literature is deficient in well designed scientific studies to support the idea that MIHA provides superior outcomes compared with Total Hip Arthroplasty(THA) performed through standard incisions. We have attempted a comprehensive quantitative review of the published literature to assess the methodology of those studies and reported surgical outcomes.

Methods: We conducted a comprehensive literature search of different online databases. All relevant articles in peer-reviewed journals were retrieved except those not mentioning outcomes, case reports, review of literature and letters to editors. Two independent authors analyzed these articles for year of publication, type of study, patient numbers, surgical method, follow-up, complications and patient satisfaction. Each article was also graded using a validated methodology score; Coleman’s Ten Criteria to assess the quality of study.

Results: 38 studies met our inclusion criteria which contained a total of 6434 hip arthroplasties.78.5% (4031) of these were MIHAs. There was significantly less intra-operative blood loss with MIS technique. However no significant difference was noted between the two groups with respect to operating time, the mean length of hospital stay, pain score, dislocation and revision rates, neurological injury and incidence of peri-operative fracture. In addition the patient characteristics and surgeon experience had a significant effect on outcome. Scores were predominantly low for quality of the studies with patient numbers, follow up time and validated outcome measures being the weakest areas.

Conclusion: Minimally invasive hip arthroplasty is clearly in its infancy and continually evolving with new techniques and instruments being developed to treat a broader range of patients. At the present time there is still a lack of quality evidence to advocate its expansion. The better designed studies in fact suggest that it should perhaps be limited further to recognised expert centres. The complication rates and learning curve may be altered by changes in training and adapting surgical techniques. We emphasize the need for meticulous design in future studies comparing the outcomes of these two procedures.