Introduction. Infection is disastrous in arthroplasty surgery and requires multidisciplinary treatment and debilitating revision surgery. Between 80-90% of bacterial wound contaminants originate from colony forming units (CFUs) present in operating room air, originating from bacteria shed by personnel present in the operating environment. Steps to reduce bacterial shedding should reduce wound contamination. These steps include the use of unidirectional laminar airflow systems and the introduction of theatre attire modelled on this principle (e.g. total body exhaust suits). Our unit introduced the use of the Stryker Sterishield Personal Protection System helmet used with laminar flow theatre systems. This study compares an enclosed helmet system used with standard gowns, with standard hood and mask attire. Method. 12 simulated hip arthroplasties were performed, six using disposable sterile impermeable gown, hood and mask and a further 6 using a Sterishield helmet and hood. Each 20 minute operation consisted of arm and head movements simulating movements during surgery. Air was sampled at wound level on a sterile draped operating table using a Casella slit sampler, sampling at 700l/minute. Samples were incubated on Blood agar for 48 hours at 37°c and the CFUs grown were counted. Results. Mean number of CFUs for the helmet was 9.33 with hood and mask attire having 49.16 CFUs (S. Ds 6.34 and 26.17; p value 0.0126). In all cases a coagulase negative staphylococcus was isolated. Conclusion. Although the sample size was small, we demonstrated a fivefold increase in the number of CFUs shed when using hood and mask attire compared to personal helmet and sterile hood. We conclude that the helmet system is superior to non-sterile hood and mask at reducing bacterial shedding by theatre personnel

Introduction. Surgical spacesuits are in widespread use. Only one previous study (JBJS 1998) has assessed the quality of the environment within the space suit. They demonstrated that surgical spacesuits could allow re-breathing of carbon dioxide (CO. 2. ). However, they had no control group and performed a vigorous exercise protocol which may have been an unfair test. The design of helmet systems has also evolved in the last decade. We have conducted the first investigation into CO. 2. levels inside the modern space suit. There is a Workplace Exposure Limit for inspired CO. 2. as determined by the Health and Safety Executive (UK), which is 0.506kPa. We wondered whether re-breathing of CO. 2. in space suits would lead to inspired CO. 2. which breaches this level. Methods. We used an anaesthetic room gas analyzer via nasal cannulae to measure inspired (ICO. 2. ) levels in 12 healthy volunteers. Readings were taken while wearing a surgical space suit with the fan on high and low settings. These were compared with a normal surgical facemask. Readings were repeated on mild exertion to simulate the effort of performing arthroplasty surgery. Results. [Frequency of ICO2 >0.5kPa (12 subjects)]. Discussion. Despite the design modifications, modern space suits allow re-breathing of CO. 2. This is more marked with exertion and with low fan settings where ICO. 2. can exceed workplace limits. This may account for symptoms of headache and drowsiness reported after a prolonged period in the suit during arthroplasty surgery. We recommend the use of high fan settings at all times

Trauma patients present with different injuries and some of them require emergency surgical procedures. Orthopaedic department at Steve Biko Academic Hospital (SBAH) have seen an increasing number of patients presenting with serious orthopaedic injuries due to Delivery Motorbike Accidents (DMBA). The aim of the study was to establish the epidemiology and pattern of orthopaedic injuries sustained following Delivery Motorbike Accident. Motor Vehicle Accident (MVA) administration office at SBAH in emergency department was approached for patients registers used between 1 January 2020 and 31 December 2022. There patients were registered as Motor Vehicle Accident (MVA), Motorbike Accident (MBA) and Pedestrian Vehicle Accident (PVA) by the administration office. The details of patients classified as MBA were collected and used to obtain clinical data from medical and radiological records in the form of patient's files and PACS respectively. Approximately 240 patients presented to Emergency department with orthopaedic injuries following a motorbike accident. About 78 files could not be retrieved from the patient's records department. About 74patients had their occupation recorded as unknown or unemployed. Approximately 70 patients had their occupation indicated in the file by the Clinicians or Administration Clerks. About 40 patients had their occupation as delivery man or working for a delivery company. 16 patients did not have images on the PACS system. Most of the patients were males, presented after hours and sustained multiple injuries that were managed surgically. Very few patients had their helmet status indicated in the file. The study suggests that accidents due to delivery motorbikes are prevalent at SBAH and result in orthopaedic injuries. Almost 50% of patients who had their occupation indicated in the file were delivery employees. A follow up prospective study is recommended to ensure complete collection of data from patients at presentation to ED

Introduction. The original Charnley-type negative pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty decades ago. Modern positive pressure surgical helmet systems (SHS) have not shown similar benefit, and several recent studies have shown a trend towards increased wound contamination and infection with SHS use. The gown glove interface may be one source of particle contamination. Objectives. The purpose of this study was to compare particle contamination at the gown glove interface in several modern SHS vs. a conventional gown. Methods. A 0.5 micron fluorescent powder was evenly applied to both hands to the level of the wrist flexion crease. After gowning in the normal fashion, the acting surgeon performed a standardized twenty minute simulated total joint replacement. The amount of gown contamination at the gown glove interface was then measured by three observers under ultraviolet light using a standardized grading scale; from 0 (no contamination) to 4 (gross contamination). Using Minitab 15, the Mann-Whitney U test was performed to compare gowns and an ordinal logistic regression analysis was performed to identify variables associated with levels of contamination. Results. All gown-glove interfaces showed some contamination. There was no difference among any of the gowns except for gown 2, which showed significantly more contamination when compared directly to each of the other four gowns (p<0.001 in each case) (Figure 1). The ordinal logistic regression analysis showed that gown type (p 0.10) was more significantly associated with contamination levels than were the other variables of observer (p 0.70), location of contamination (p 0.56), or trial order (p 0.5). Conclusions. Particle contamination occurs at the gown glove interface in most commonly used surgical helmet systems and was significantly increased in the gown with stiffer material that may be less apt to make a seal with the glove

Surfing is a popular UK water-sport. Recommendations for protective gear are based on studies abroad from trauma from large waves and reef breaks which may not be relevant in the UK. This study assesses the aetiology of UK surfing injuries in order to assist treatment and provide formative recommendations on protective equipment. Data was collected from UK surf clubs via an online survey. 130 individuals reported 335 injuries. M:F ratio 85:45, median age 28 (range 17–65). Head injuries were the most common (24%) followed by foot and ankle (19%). Surfers collided most often with their own boards (31%) followed by rocks/coral (15%), the sea (11%) and other surf boards (10%). Lacerations were the commonest injury (31%); followed by bruises/ black-eyes (24%) and joint/ligament sprains (15%). Concussions (5%), fractures (3%) and teeth injuries (1%) were rare. Less than 1/3 of all injuries required professional medical attention, 2 required operative intervention. Surfing injuries in the UK are common but usually minor. Serious head injuries (fractures and concussions) are rare. There is insufficient evidence to warrant the routine use of protective helmets whilst surfing in the UK, although protective head and foot gear may be considered when surfing the rarer reef/ rock breaks

Sledging related minor and major injuries represent a significant workload at ski-area medical centers across the world. Although safety rules exist, they are seldom obeyed or enforced. We set out to determine the incidence of sledging related injuries, identifying trends and causative factors at a busy New Zealand Ski resort. All sledging related injuries presenting during a 70-day period were prospectively reviewed. Patient demographics, mechanism, diagnosis, and treatment were recorded. Sixty patients were identified, mean age 10 years, range 4-30 years. Injuries comprised; collisions with sledgers (21), collision with wall (14) and falling from sledge (14). Site of injury included head (36), lower limb (18), spine (9), upper limb (7), and abdomen (2). Fractures included; femur (1), tibia (1), fibula (1), ankle (2), cuboid (1), clavicle (2), scaphoid (1). One 9-year-old patient sustained a serious intracranial haemorrhage, with subsequent permanent neurological sequelae. Sledging related injuries are mostly minor, however significant major injuries do occur requiring intervention at a secondary center. The potential for serious morbidity is evident. Recommendations supporting safety improvement measures does exist, however most were not implemented by the study cohort examined. The use of basic cycling helmets would seem an appropriate minimum level of protection, and greater sledging safety awareness should be encouraged

The amount of time spent in theatre by trainees is decreasing and therefore it seems crucial to fully optimis e these to enable adequate training. Trainees at the beginning of their practice, despite their exposure to surgery, cannot always take advantages of the surgical procedure they are assisting with. An obvious example of this is total hip replacement during posterior approach. Although the posterior approach and less invasive or minimally invasive approaches are certainly beneficial for patients, they are very difficult for a young trainee to comprehend, as they spend most of the time hanging onto the retractor without or rarely seeing the important anatomic steps of the procedure. Our goal was to develop a tool that would help a trainee to fully see and understand the surgical steps of total hip replacement during a posterior approach. To enable visualisation of the operation from the senior surgeon's perspective we developed a device to film the surgery and output the video feed to a screen. The prototype used an HD Replay XD1080 camera connected to a WDHI Xenta transmitting dongle (transmitting frequency −5.8 GHz), with an onboard 6600 mAh external Li-Mh battery providing 1A of current to the system. The Replay camera was fixed to the surgeon's ventilation helmet, and took its power from the battery supplying both the fan system and the transmitting unit. The surgeon can then clip both of these items to his belt and the connecting wires and cables run up his back. The device provided a Full HD video output of the surgery from the surgeon's perspective. The receiving unit used a Xenta WHDI wireless receiver with HDMI and DVI-I/D connections allowing the video to be displayed on any screen in the operating room with these connections. The prototype has been trialled by the senior author and was successful in allowing the direct surgeon's view of the procedure to be displayed on a screen in the theatre so that other staff involved in the operation could see it. Although the use of virtual training, presentations and video are essential to training, surgical training still relies greatly upon surgical assistance. The introduction of an intra-operative video feedback device would enable trainees to observe the operation from a first-person perspective which could lead to a considerable reduction in the amount of training time required, as well as a better understand of the specific surgical steps in a procedure. This would be particularly use for operations where a trainee assists the surgeon from the opposite side of the operating table, for example when undergoing total hip replacement during posterior approach. We can also envision this device also being used by surgeons to monitor their trainees when operating, and perhaps to keep a record of the operations undertaken in an establishment for archiving or assessment

Aim

The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally. Orthopaedic surgeons are at risk of contracting COVID-19 due to their close contact with patients in both outpatient and theatre environments. The aim of this review was to perform a literature review, including articles of other coronaviruses, to formulate guidelines for orthopaedic healthcare staff.

Aims

The COVID-19 pandemic presents an unprecedented burden on global healthcare systems, and existing infrastructures must adapt and evolve to meet the challenge. With health systems reliant on the health of their workforce, the importance of protection against disease transmission in healthcare workers (HCWs) is clear. This study collated responses from several countries, provided by clinicians familiar with practice in each location, to identify areas of best practice and policy so as to build consensus of those measures that might reduce the risk of transmission of COVID-19 to HCWs at work.