Summary Statement. This study assesses the service provision of viscosupplementation within an NHS (British National Health System) hospital. The results of this study show long term efficacy of the treatment, when provided by a dedicated, orthopaedic unit. Introduction. The service provision of viscosupplementation for osteoarthritis within the National Health System (NHS) remains controversial. The treatment was recommended in the 2007 NICE guidelines but support was withdrawn the following year. Furthermore, whether it should be provided by orthopaedic surgeons or in primary care is also a matter of debate. St Helens and Knowsley Trust, runs an orthopaedic outpatient clinic dedicated to the administration of viscosupplementation to patients with symptomatic knee osteoarthritis. This study aims to assess the efficacy of viscosupplementation for knee osteoarthritis when that is provided by a highly specialised, orthopaedic, dedicated service. Patients and Methods. Between January 2011 and June 2011, 103 patients underwent Ostenil® intra articular knee injections in our clinic. The viscosupplement used is Ostenil®, a 20mg/2ml sodium hyaluronate as an isotonic solution contained in a single syringe. Patients are given a regimen of 3 × 20mg/2ml Ostenil® injections. The time interval between injections is two weeks. They were all given a “pain diary” and were asked to document their pain score on a Visual Analogue Scale (from 0 to 10), prior to the treatment, the day of procedure and up to 3 months after the procedure. 72 patients (M:F 34:38, Mean age: 60.3 years) participated in the study (Right knee 31, Left 22 and Bilateral 19). Mean pre treatment and post treatment score amongst all patients were calculated up to three months post treatment. Results. Results show a continuous decreasing trend in pain scores up to three months after the procedure. Indicatively, mean pre treatment pain score was 6.88, mean pain score on day 3 (2 days post first injection) is 4.89, mean pain score on Day 31 (2 days after 3rd injection) is 4.37. Pain levels are maintained low at Week 6 after treatment (4.43) and Month 3 (4.37). A small peak in pain score was identified up to 48hrs after the injections but that has been already identified in current literature as a result of short term inflammation due to the injection process. Conclusion. Viscosupplementation for knee osteoarthritis is an efficient treatment when provided by an orthopaedic, dedicated service. The duration of the reduction in pain with a three injection course is at least 3 months. This study also demonstrates that an overall 3 injection course with a time interval of 2 weeks between injections is sufficient to produce long lasting results

The British Orthopedic Association recommends that patients referred to fracture clinic are reviewed within 72 hours. With the increase in referrals and limited clinic capacity it is becoming increasingly difficult to see every referral with in a 72 hour time frame. Some patients are waiting 2 weeks or more before they can be seen in a fracture clinic. With the aim of improving care by seeking to meet BOAST 7 target, waiting times for fracture clinic appointments at the Homerton University Hospital were audited prospectively against this national guideline, before virtual fracture clinic was implemented and 6 weeks after the implementation of virtual fracture clinic at our hospital. Virtual fracture clinic is where an Orthopedic consultant reviews a patients x-rays and A&E documentation and decides if that patients needs to be seen in a face to face fracture clinic to discuss operative vs. non-operative management of their injury or if a treatment plan can be delivered without the patient having to come back to hospital. The study was conducted as a prospective closed-loop audit in which the second cycle took place after the implementation of the new virtual fracture clinic service. The first cycle showed a non-compliant waiting time with only 18% of patients being seen within 72 hours. Following the implementation of virtual fracture clinic, 84% of all patients were reviewed within 72 hours. Virtual fracture clinic delivered a significant reduction in waiting times. Virtual fracture clinic has only just been implemented at the Homerton University Hospital and hopefully at the next audit we will be 100% compliant with the BOA BOAST 7 Guideline. We would recommend that virtual fracture clinics being rolled out in Orthopedic departments in all hospitals which have Orthopedic services

With an ageing population and increasing pressures on all orthopaedic services, it is vital that we are able to develop efficient and acceptable means to streamline the patient journey. Our department uses telephone review appointments for selected patients to reduce the need for additional visits to the outpatient clinic. The aim of this study was to assess the efficacy of this approach, and to determine whether it was acceptable to patients. We identified all patients who had received a first-time telephone review appointment within a four month period. Using a short structured telephone questionnaire they were asked about their experiences of the process, whether they had subsequently required a clinic visit, and whether they would have preferred to be seen in person in the clinic. 50 of the 55 (91%) patients were successfully contacted, and all gave consent to participate. Reasons for follow-up included post-operative discectomy and lumbar decompression, post-nerve root injection, and MRI results. All patients (100%) were satisfied with the telephone consultation. Only 8 (16%) would have preferred a clinic appointment with 5 of these subsequently visiting the clinic. 32 (64%) of the patients did not require a further clinic appointment for the same problem. 32 (64%) of patients stated that they were very satisfied with the overall follow-up process with the remaining 18 (36%) being satisfied. Our study has shown that using telephone review follow-up for selected patients is effective at reducing the number of clinic visits, and is acceptable to patients

Few doctors answer their bleep by stating who they are. Answering the phone in a formal manner is of utmost importance in the hospital setting especially by on-call teams who are normally referred patients by other specialties, general practitioners and in some cases by other hospitals. An audit to evaluate the internal hospital communication was completed. In the first part of this audit, junior doctors within the orthopaedic department at the RAH were bleeped. Doctors were expected to answer by initiating the conversation by stating (1) name, (2) department, (3) grade and (4) a greeting. A list of omissions was recorded. If the call went through switchboard, it was expected that the hospital name was stated. The second part of the audit extended to other specialties in the RAH as well as orthopaedic departments in hospitals within the Greater Glasgow and Clyde health board (NHS GGC). Forty-three bleeps were made to doctors of various grades over a period of two months. Nine bleeps (two from other hospitals) were not answered. Five doctors answered their bleep in full. Only twenty-one doctors stated their name whilst eleven stated their grade. In both instances the department was not necessarily stated. The results were similar between the different departments as well as between the seven hospitals offering an orthopaedic service within NHS GGC. Of the thirteen on-call doctors that were bleeped as an external call through switchboard, only one doctor stated the hospital name. This has implications since most hospitals within NHS GGC share a common switchboard. These results emphasise the need for a protocol within NHS GGC for a standard etiquette for intra and inter hospital communication to ensure that patient safety and confidentiality is safeguarded

Forearm fractures are a common paediatric injury. This study was aimed to describe the epidemiological of paediatric forearm fractures in the urban population of Glasgow. We reviewed of all the forearm fracture treated by the orthopaedic service in Yorkhill Children's Hospital in 2008. Datum gathered from case notes and radiographs using the prospective orthopaedic database to identify patients with forearm fractures. The age, sex, side and type of fracture, the timing and mechanism of the injury and treatment were documented for the 436 fractures. Census data were used to derive absolute age-specific incidences. Distinction was made between torus and other types of fractures. Torus fractures require no specific orthopaedic treatment and were segregated out. For the remaining 314 fractures, the age and sex distribution, seasonal variation of fractures and treatments for each type of fracture were examined. The incidence of forearm fractures in our population is 411 fractures per 100,000 population per year. An increased number of fractures occurred during the months of May and August. A fall from less than one metre was the commonest mechanism of injury, sporting injuries were the second commonest with football the most common sport associated. This study identifies some features which are in good agreement with studies from elsewhere in Britain, such as incidence and seasonality. However, there are also interesting differences – such as the Glasgow peak incidence for forearm fractures being at age 8, with a marked decline by 12 years. Furthermore, our findings have been extended to consideration of type of intervention, and likelihood of successful treatment

NHS Greater Glasgow & Clyde has six hospitals that provide an inpatient trauma service, but only two have facilities to receive patients by helicopter. The Southern General Hospital contains regional Neurosurgical and Spinal Injuries services and attracts the majority of major trauma delivered by helicopter. This study explores the impact that Emergency Medical Retrieval (EMRS) and Air Ambulance services have on the Trauma & Orthopaedic department at our Hospital. We examined the period 1. st. January 2010 to 31. st. December 2010 identifying Trauma & Orthopaedic admissions brought to our hospital by the Emergency Medical Retrieval and Air Ambulance services. These patients were identified from records kept by our Trauma Nurse Practitioner and an additional search of the hospital admissions database. Details of the admissions were extracted from this database, clinical records and various electronic patient records. Patients admitted to other departments were excluded from the study. 48 admissions (30 male, 18 female) were identified. Age ranged from 16-87 years. 16 patients had multiple injuries. 8 required High-Dependency or Intensive Care admission and there was 1 death in our cohort. 21 patients required surgery. In total, these patients required approximately 52.5 hours of operative time. These patients accounted for 373 inpatient days with an average hospital stay of 7.7 days (1-36 days). In addition, 25 patients have required a total of 35 outpatient appointments to date. This study quantifies the significant impact on inpatient and outpatient Trauma & Orthopaedic services from helicopter derived admissions. Some patients admitted under Neurosurgery and Spinal Injuries also undergo surgery, but were not included in the study, representing an additional workload. We believe this study supports an argument for additional investment in this growing trauma service, especially given the recent expansion of EMRS to cover the whole of Scotland

Summary Statement. With increasing emphasis on evidence-based medicine in healthcare, there is global increase in proportion of Level-1 and -2 articles in PUBMED. This study shows the trend of orthopaedic publications from different countries in comparison to other specialties. Introduction. New medical knowledge is expected to improve health through change in existing practices. Articles need to convince readers of the validity of conclusions in order to bring about a change in practice. The last few decades have witnessed an increasing interest in critical appraisal of research aimed at assessing the ‘quality’ of evidence, a trend towards ‘Evidence Based Medicine’. Whether orthopaedic publications are also becoming more evidence-based has hitherto not been reported. This study aimed to compare the trend of publications originating from orthopaedic services versus other specialties, across different countries, with respect to major categories of levels of evidence. Methods. PUBMED was used to collect data on yearly publication of articles, categorised by country, specialty (from author address) and article category (Guideline, Review, Case Report, Comparative Study, Clinical Trial and Meta-Analysis). Results. PUBMED shows 20,572,125 articles published between 1900 and 2010. Of these, 64% were published within the quarter century 1986–2010. Publication type was specified in 25% of articles, of which 8% were review articles, 7% each were case reports and comparative studies while 3% were clinical trials. The top ten countries from which articles originated were US, UK, Japan, Germany, France, Canada, Italy, Australia, Netherlands and Sweden. Comparing the decade of 1990s with 2000s, the number of meta-analyses showed greatest increase from Australia, Japan, Germany, UK and Italy (9.5x-6.1x). When comparing types of articles between the beginning and end of the quarter century, the proportion of clinical trials increased by 2x, guidelines by 5x and meta-analyses/systematic reviews by 28x. There were 121,859 articles from orthopaedic departments/institutes (0.6% of all articles). There was a consistent increase in the proportion of orthopaedic publications from 0.5% to 1.1% over the quarter century; this 231% increase was lower than vascular, cardiothoracic and paediatric surgery but greater than urology, neurosurgery, otolaryngology and obstetrics/gynecology. Among the different types of publications, in orthopaedics the greatest increase between the decades of 1990s and 2000s was in meta-analyses (8.5x) followed by guidelines (5.4x). This increase in number of meta-analyses was higher than other surgical specialties except cardiothoracic and vascular surgery, both of which showed a 13x increase. Among the meta-analyses from surgical specialties, the proportion from orthopaedics and vascular surgery was increasing consistently, with the former now contributing to 13% of all meta-analyses. In comparison, increase in number of clinical trials has been relatively modest for orthopaedics (2.4x), being lower than vascular surgery (3.3x), plastic surgery (2.8x) and neurosurgery (2.6x). Dicussion/Conclusion. The proportion of clinical trials and guidelines was increasing in a linear fashion in the last 25 years, while the proportion of meta-analyses/systematic reviews was increasing logarithmically. Among European countries, Germany, UK and Italy contributed to the highest number of meta-analyses. Publications from orthopaedic departments showed an overall intermediate rate of increase, but meta-analyses/systematic reviews showed a consistently higher increase compared to other surgical specialties. This analysis shows the trend of orthopaedic evidence in published literature and may be used as a guide to future country-specific research directions in the discipline of orthopaedics

Objectives

“Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway.