Hip precautions are currently practiced in three-quarters of trauma hospitals in the UK, despite national recommendations from the ‘Blue Book’ not stating it as a requirement. Valuable therapist time is utilised alongside the need for specialised equipment, which can potentially delay discharge whilst it is being arranged. Objective of this study was to explore the current practice of the use of hip precautions on discharge following hemiarthroplasty for hip fractures. To also explore whether they are necessary and to identify areas for improvement to benefit patient care overall. Online survey distributed to various Trauma and Orthopaedic Departments across the UK. Survey was available over a 4-month period, collecting 55 responses overall. Majority of responses were from trauma and orthopaedic consultants who were aware of the ‘Blue Book’ recommendations. The majority of trusts who responded did not practice hip precautions and did not feel this increased the risk of dislocations on discharge. Recommendations included integration of hip precautions in the post-op advice in coordination with the physiotherapist and information leaflets on discharge regarding hip precautions. Hip precautions were not commonly practiced, for reasons including patient compliance and the inherently stable procedure of a hemiarthroplasty compared to a THR, reducing the need for hip precautions. Hip precautions are not widely regarded as a useful practice for post-hip hemiarthroplasty, viewed as utilising more resources and increasing costs and risk due to increased hospital stay. Thus, this potentially delays discharge overall. A consistent approach should be implemented in treating patients post-hip hemiarthroplasty

Background. This survey was conducted to gain information about how surgeons use scientific literature and how this is influenced by their knowledge of evidence-based medicine. The results were compared to a survey conducted 10 years previously. Where appropriate, the same questions as in the 2003 survey were used. Methods. We administered a voluntary questionnaire to participants at the AO Foundation courses in Davos, Switzerland, in December 2013. We surveyed, amongst other topics, the surgeons’ levels of education in Evidence-Based Medicine (EBM), how they implement EBM in daily practice and their publication record. Results. A total of 330 surgeons completed the 27 question survey. 49% (159/322) had learned about EBM in medical school. However, 69% (110/159) of those with EBM education had taken only one semester or less on the subject. 54% of participants (170/317) correctly identified a definition of EBM in surgery. This compares to 45% in the 2003 survey (130/288 respondents) of a subset who said they have previously heard of evidence-based orthopaedic surgery. When it came to applying EBM in their daily work, 45% of respondents (143/320) claim to always practice it (2003 figure: 28%, 113/404), while 26% (84/320) only use EBM for difficult or controversial cases (2003 figure: 26%, 104/404). 27% (88/323) have never published a manuscript as an author or co-author (2003 figure: 14%, 121/453), 53% (170/323) have been involved in 1–10 publications (2003 figure: 59%, 269/453), and 20% (65/323) have published more than 10 times (2003 figure: 27%, 63/453). Conclusions. While at face value there appears to be a greater understanding and utilisation of EBM among AO course participants who completed the 2013 survey compared to the 2003 study, several outcomes do not show any great variation in the intervening decade. Level of Evidence. professional survey

Objectives. Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making. Materials and Methods. A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns. Results. A total of 353 surgeons completed the survey. Surgeons achieved consensus on the ‘importance’ of three key designs on their practices: randomised controlled trials (94%), meta-analyses (75%) and systematic reviews (66%). The vast majority of respondents support the use of current evidence over historical clinical training; however subjective factors such as journal reputation (72%) and investigator profile (68%) continue to influence clinical decision-making strongly. Conclusion. Although intrinsic factors such as study design and sample size have some influence on clinical decision-making, surgeon respondents are equally influenced by extrinsic factors such as investigator reputation and perceived journal quality. Cite this article: Dr M. Ghert. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016;5:130–136. DOI: 10.1302/2046-3758.54.2000578

Objectives. To explore whether orthopaedic surgeons have adopted the Proximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial results routinely into clinical practice. Methods. A questionnaire was piloted with six orthopaedic surgeons using a ‘think aloud’ process. The final questionnaire contained 29 items and was distributed online to surgeon members of the British Orthopaedic Association and British Elbow and Shoulder Society. Descriptive statistics summarised the sample characteristics and fracture treatment of respondents overall, and grouped them by whether they changed practice based on PROFHER trial findings. Free-text responses were analysed qualitatively for emerging themes using Framework Analysis principles. Results. There were complete responses from 265 orthopaedic and trauma surgeons who treat patients with proximal humeral fractures. Around half (137) had changed practice to various extents because of PROFHER, by operating on fewer PROFHER-eligible fractures. A third (43) of the 128 respondents who had not changed practice were already managing patients non-operatively. Those who changed practice were more likely to be younger, work in a trauma unit rather than a major trauma centre, be specialist shoulder surgeons and treat fewer PROFHER-eligible fractures surgically. This group gave higher scores when assessing validity and applicability of PROFHER. In contrast, a quarter of the non-changers were critical, sometimes emphatically, of PROFHER. The strongest theme that emerged overall was the endorsement of evidence-based practice. Conclusion. PROFHER has had an impact on surgeons’ clinical practice, both through changing it, and through underpinning existing non-operative practice. Although some respondents expressed reservations about the trial, evidence from such trials was found to be the most important influence on surgeons’ decisions to change practice. Cite this article: L. Jefferson, S. Brealey, H. Handoll, A. Keding, L. Kottam, I. Sbizzera, A. Rangan. Impact of the PROFHER trial findings on surgeons’ clinical practice: An online questionnaire survey. Bone Joint Res 2017;6:590–599. DOI: 10.1302/2046-3758.610.BJR-2017-0170

The role of perioperative antibiotic prophylaxis in sarcoma surgery is well established. There are no guidelines for their use in this context but there is pressure from microbiologists to comply with agreed prophylaxis for joint arthroplasty despite major differences between patient groups and risks of infection in sarcoma surgery. Two simple surveys were conducted online, the first for bone sarcoma surgery, the second for soft tissue sarcomas. An email was sent to the major centres worldwide conducting such surgery with links to the online surveys to assess current practice regarding antibiotic prophylaxis and surgical drains. The survey was limited to 8 questions, the emphasis being a simple survey, but included questions on indications, choice, duration of therapy as well as use, size and duration of surgical drains. We received 38 responses from 15 countries to the bone sarcoma survey and 33 responses from 12 countries to the soft tissue sarcoma survey. Current antibiotic prophylaxis regimens varied widely among surgeons, emphasising the controversy that exists regarding what constitutes best clinical practice. Opinions regarding use of perioperative antibiotic prophylaxis in sarcoma surgery vary widely among orthopaedic surgeons worldwide, illustrating the controversy as to what constitutes best clinical practice. This survey suggests the need for a randomised clinical trial to aid in the development of guidelines in this area

Around 1% of the 185,000 primary hip and knee arthroplasties performed in the UK are followed by prosthetic joint infection (PJI). Although PJI affects a small percentage of patients, it is one of the most devastating complications associated with this procedure. Treatment usually involves further major surgery which can adversely affect patients' quality of life. Understanding current service provision provides valuable information needed to design and evaluate support interventions for patients. The aim of this survey was to identify usual care pathways and support in UK NHS orthopaedic centres for this population. The 20 highestvolume UK NHS orthopaedic centresfor hip and knee arthroplasty account for 33–50% of all cases treated for prosthetic joint infection. Infection leads at each centre were invited to participate in a survey about usual care provision and support for PJI. Questions exploredfollow up time-points; use of standard outcome measures; multidisciplinary care plans; supportive in-patient care and care after treatment; and onward referrals. Survey responses were recorded on a standardised proforma. Data were entered into Excel for analysis, then reviewed and coded into categories and frequency statistics to describe categorical data. A descriptive summary was developed based on these categories. Eleven of the highestvolume orthopaedic centres completed the survey. Follow-up of patients varied greatly across centres; some centres reviewed patients at weekly or 2 week intervals, while all centres saw patients at 6 weeks. Long-term follow-up varied across centres from 3–4 monthsto 12 monthly. Length of follow-up period varied from until the infection had cleared toindefinitely. Follow-up timepoints were only standardised in 4 out of 11 centres. Only 1 centre had a dedicated infection clinic. Advice on who patients should contact if they had concerns included the consultant, community nurse, extended scope practitioner or the ward, while 3 centres told patients to avoid calling their GP. Only half of the centres routinely used standardised outcome measures with patients with PJI. The majority of centres provided standard physiotherapy and occupational therapy (OT) to in-patients while approximately half also offered social support. Only one centre provided dedicated physiotherapy and OT on a separate infection ward. Three centres provided hospital at home or community services to patients in-between operative stages. Only 3 out of 11 centres stated they had specific multidisciplinary care plans in place for patients. Once discharged most patients were provided with physiotherapy, OT and social services if needed. Common barriersto referral included complexities of referring patients outside the hospital catchment area;lack of availability of community services, and shortage of staff including physiotherapists. Delays in rehab and social services could also be problematic. Findings show wide variation intreatment pathways and support for patients treated for PJI, both as inpatients and in the community. Only one of the 11 centreswho participated had a dedicated infection clinic. Only one centre suggested they individualised their physiotherapy support. A number of barriers exist to referring patients on to other support services after revision surgery

Summary. There is little knowledge in surgeons about the guidelines for prophylactic antibiotics in patients with prosthetic joints when undergoing a dental procedure. This study confirms this and there is need for robust and universal guidelines given the disastrous nature of prosthetic infection. Introduction. Infection as an indication for revision has increased to 12 % of the total revisions (NJR 9. th. report). However, it is next to impossible to find out the cause for a delayed prosthetic infection. With increasing number of arthroplasty procedures, is there a need for prophylactic antibiotics in patients with prostheses?. Methods. At London Knee Meeting 2012, a total of 163 surgeons were asked to take part in a survey. This was to find out if they knew of any existing guidelines for prophylaxis for dental procedures, if there was a need to practice more uniformly, and if they recommend such prophylaxis to their patients routinely. The grade of the surgeon and their experience in years was also noted. Results. Among the 163 surgeons who participated, 102 (62.6%) were arthroplasty surgeons. Of these, 73 (71.5%) were consultants with 3 or more years of experience. For this study, responses from these 102 surgeons were taken into consideration. Out of the 102 surgeons, only 39 (38%) were aware of AAOS recommendations. However, only 26 (25.5%) felt the need for such prophylaxis, other 37 (36%) were not sure if such prophylaxis was necessary. The remaining 39 (38.5%) did not think the prophylaxis was necessary. There was no difference found in the responses between the consultant and non-consultant surgeons. Conclusions. From this survey, it is clear that there is no uniformity of the knowledge of existing recommendations for prophylaxis of such patients with prostheses. There is probably a need to develop robust guidelines for prophylaxis, given the devastating nature of an infected prosthesis

Adequate range of knee motion is critical for successful total knee arthroplasty. While aggressive physical therapy is an important component, manipulation may be a necessary supplement. There seems to be a lack of consensus with variable practices existing in managing stiff postoperative knees following arthroplasty. Hence we did a postal questionnaire survey to determine the current practice and trend among knee surgeons throughout the United Kingdom. A postal questionnaire was sent out to 100 knee surgeons registered with British Association of Knee Surgeons ensuring that the whole of United Kingdom was well represented. The questions among others included whether the surgeon used Manipulation Under Anaesthaesia (MUA) as an option for stiff postoperative knees; timing of MUA; use of Continuous Passive Motion (CPM) post-manipulation. We received 82 responses. 46.3% of the respondents performed MUA routinely, 42.6% sometimes, and 10.9% never. Majority (71.2%) performed MUA within 3 months of the index procedure. 67.5% routinely used CPM post-manipulation while 7.3% of the respondents applied splints or serial cast post MUA. 41.5% of the surgeons routinely used Patient Controlled Analgaesia +/− Regional blocks. Majority (54.8%) never performed open/arthroscopic debridement of fibrous tissue for adhesiolysis. Knee manipulation requires an additional anaesthetic and may result in complications such as: supracondylar femur fractures, wound dehiscence, patellar tendon avulsions, haemarthrosis, and heterotopic ossification. Moreover studies have shown that manipulation while being an important therapeutic adjunct does not increase the ultimate flexion that can be achieved which is determined by more dominant factors such as preoperative flexion and diagnosis. Manipulation should be reserved for the patient who has difficult and painful flexion in the early postoperative period

Background and purpose. Over the past decade, it has become apparent that more often than not musculoskeletal pain occurs in more than one site in an individual, and traditional approaches, where pain has been studied as a narrow site-specific problem, are often not feasible. The overall aim of this study is to describe clusters of pain using a large population-based sample. This presentation will focus specifically on musculoskeletal co-complaints in back pain sufferers. Methods and results. The Danish National Institute of Public Health has since 1987 conducted national representative health interview surveys of the adult Danish population some of which have included questions on musculoskeletal complaints. We used latent class analysis to identify latent classes of musculoskeletal complaints that occurred alongside a primary complaint of back pain. In addition, probabilities that specific sites occurred as co-complaints were determined. Three latent classes were identified and they exhibited quite different patterns of musculoskeletal co-complaints. The most commonly occurring class had a low probability of any co-complaints, the second most commonly occurring class had a high probability of pain in the neck, shoulders and mid-back, while the least commonly occurring class had very high probabilities of pain at all other body sites. Conclusions. Latent class analysis can be used to identify distinctly different groups of pain patterns in persons primarily complaining of back pain. The three groups identified likely have very different prognoses. Conflicts of Interest. None. Source of Funding. None. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

Background

Tourniquets are routinely used in total knee arthroplasty (TKA) with an estimated use by up to 93% of surgeons. Advantages include the ability to provide a bloodless field of view to facilitate cement application and increase the success of the procedure. Overall reduction in blood loss is another perceived advantage, however recent research has demonstrated no measurable reduction and conversely a substantial increase in complications such as deep vein thrombosis and systemic emboli. Given the significant complications of tourniquet use we aim to identify patients’ views on tourniquets and of emphasis their awareness of the possible risks involved prior to the procedure.

Background

Tourniquets are routinely used in total knee arthroplasty (TKA) with an estimated use by up to 93% of surgeons. Advantages include the ability to provide a bloodless field of view to facilitate cement application and increase the success of the procedure. Overall reduction in blood loss is another perceived advantage, however recent research has demonstrated no measurable reduction and conversely a substantial increase in complications such as deep vein thrombosis and systemic emboli. Given the significant complications of tourniquet use we aim to identify patients' views on tourniquets and of emphasis their awareness of the possible risks involved prior to the procedure.

Chronic pain is recognised as a problem worldwide. Interdisciplinary multimodal pain therapy (MMPT) is currently the gold standard of treatment. The aim of the present prospective observational study is to research whether chronic pain patients form an intention for lifestyle change during a 4-week-long treatment at the Outpatient Clinic for Pain Therapy and Conservative Orthopedics in Heidelberg, Germany, and how sustainable this change is after 3 months. In addition, we theorized a connection between standardised survey endpoints and the number of therapy units perceived as helpful (TPAH). Finally, the effect of socio-demographic factors on patient perceptions were put into perspective. Clinical data was collected via 3-part-questionnaires from 95 German-speaking patients at 4 checkpoints between 05/2020 and 11/2021 at admission (T1), after 2 weeks (T2), at discharge (T3) and 3 months post-treatment (T4). The questionnaires consisted of already established scores for surveying chronic pain patients, such as the von Korff Chronification Scale, ODI, HADS, PSEQ/FESS, and FABQ, a grading scale for each therapy unit, and free answers. Patients were most likely to implement Group Walking in their everyday lives. A higher number of TPAH neither lowered nor improved significantly the change in lifestyle, but both a higher number and bigger lifestyle changes improved significantly the scores across the standardised surveys. Furthermore, no significant change in intention happened between the second and the fourth week. Physical components were perceived throughout as more helpful. The results of this research support the efficacy of MMPT in multi-faceted improving of the patient's well-being and lowering the possibility for pain chronification. A higher number of TPAH could be translated as having more available techniques to combat chronic pain in everyday life. The number of TPAH and the amount of lifestyle change both influence positively the survey scores, yet no connection between them was found. A third factor could be the reason for this constellation. The possibility that the more mental therapies are offered, the more likely it is for those to be perceived as helpful, cannot be excluded either. Further research is required on both topics

Abstract. Objectives. Osteoporotic fractures tend to be more challenging than fractures in healthy bone and the efficacy of metal screw fixation decreases with decreasing bone mineral density making it more difficult for such screws to gain purchase. This leads to increased complication rates such as malunion, non-union and implant failure (1). Bioresorbable polymer devices have seen clinical success in fracture fixation and are a promising alternative for metallic devices but are rarely used in the osteoporotic population. To address this, we are developing a system that may allow osteoporotic patients to avail of bioresorbable devices (2) but it is important to establish if patients have any reservations about having a plastic resorbable device instead of a metal one. Therefore the aim of this study was to explore the acceptability of bioresorbable fracture fixation devices to people with osteoporosis. Methods. A cross sectional descriptive study was conducted in a UK wide population using convenience sampling. An online survey comprising nine survey questions and nine demographic questions was developed in Microsoft Teams and tested for face validity in a small pilot study (n=6). Following amendments and ethical approval, the survey was distributed by the Royal Osteoporosis Society on their website and social media platforms. People were invited to take part if they lived in the UK, were over 18 years old and had been diagnosed with osteoporosis. The survey was open for three weeks in May 2023. Responses were analysed using descriptive statistics. Results. There were 112 responses. Eight participants had not been diagnosed with osteoporosis and therefore did not meet the study criteria. Of the remaining 104, 102 were female and 2 were male and 102 were white (2 chose not to disclose their ethnicity). The majority of participants were aged 55–64 (34.6%) or 65–74 (37.5%), were college/university educated (38.5%) and had previously sustained a fragility fracture (52.9%). Only 3.9% of participants had heard of bioresorbable fracture fixation devices compared to 62.5% for metal devices. Most people were unsure if they would trust one type of device over the other (58.7%) and would ask for more information if their surgeon were to suggest using a bioresorbable device to fix their fracture (61.5%). The most commonly reported concerns were about device safety and efficacy: toxicity of the degradation products and the device breaking down too early before the fracture had healed. Two participants cited environmental concerns about increased use of plastics as a reason they would decline such a device. Conclusions. As expected, participants had little to no knowledge of bioresorbable polymer fixation devices. In general, they were willing to be guided by their surgeon but would require supporting information on the safety and efficacy of their long-term use. The results of this study show that it will be important to have relevant and understandable information to give patients when recommending these devices as treatments to ensure and support a shared-decision approach to patient care. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

While the COVID-19 pandemic highlighted the need for more accessible anatomy instruction tools, it is also well known that the time allocated to practical anatomy teaching has reduced in the past decades. Notably, the opportunity for anatomy students to learn osteology is not prioritised, nor is the ability of students to appreciate osteological variation. As a potential method of increasing accessibility to bone models, this study describes the process of developing 3D-printed replicas of human bones using a combination of structured light scanning (SLS) technology and 3D printing. Human bones were obtained from the Anatomy Lab at the University of Edinburgh and were digitised using SLS via an Einscan H scanner. The resulting data was then used to print multiple replicas of varying materials, colours, scales and resolutions on an Ultimaker S3 3D printer. To gather opinion on these models and their variables, surveys were completed by anatomy students and educators (n=57). Data was collected using a Likert scale response, as well as free-text answers to gather qualitative information. 3D scans of the scapula, atlas (C1 vertebrae) and femur were successfully obtained. Plastic replicas were produced with defined variables in 4 separate stations e.g. different colours, to obtain results from survey respondents. For colour, 87.7% of survey respondents preferred white models, with 7% preferring orange and 5.3% preferring blue. For material, 47.4% of respondents preferred PLA (Polylactic acid), while 33.3% preferred ABS (Acrylonitrile butadiene styrene), 12.3% preferred Pet-G (Polyethylene terephthalate glycol), 3.5% preferred Glassbend and 3.5% had no preference. Additional results based on scale and resolution were also collected. This initial study has demonstrated a proof-of-concept workflow for SLS technology to be combined with 3D printing to produce plastic replicas of human bones. Our study has provided key information about the colour, scale, material and resolution required for these models. Our future work will focus on determining accuracy of the models and their use as teaching aids for osteology education

The purpose of the this survey study was twofold: 1) to examine different aspects of satisfaction with post-operative care in injured workers who have undergone rotator cuff surgery and 2) to examine the relationship between receiving a newly implemented summary report and the overall satisfaction with surgery and recovery. The clinical communication summary report was given to injured workers following their review assessment to share with the family doctor or other health care providers. The form indicated a need for further assessments or investigations and return to work recommendations. The study involved using a satisfaction survey that examined different aspects of follow-up visit and workers’ opinion about their understanding of the nature of surgery, their progress, clinical management, and usefulness of the newly implemented summery report. Eighty patients completed the questionnaire (mean age: 54 (8), 62(78%) males, of whom 26 (34%) had a rotator cuff decompression and 31 (40%) had a rotator cuff repair with 20 (26%) having both procedures and three missing data. There were no statistically significant relationships between the patient demographics (age, sex or type of surgery) and satisfaction. However, there was a significant correlation between how patients perceived the summary report in terms of helpfulness and the overall satisfaction with surgery (FTE<0.0004, p=0.001) and the satisfaction with recovery (FTE<0.0001, p=0.001). This may indicate that improvement in worker's understanding of their treatment recommendations and restrictions is associated with higher levels of overall satisfaction in this population. Our results indicate a positive linear relationship between expressing a high satisfaction and the helpfulness of the summary report. As part of improving care, adding a summary report may facilitate sharing information with the injured workers, their care providers and their workplace

Since the emergence of the COVID-19 pandemic, the NHS has been under unprecedentedpressure. Elective surgery had ceased, and trauma surgery has decreased dramatically. Surgical training is multi-faceted and requires a specialist trainee to have a timetable which includes regular elective non-emergency operating, trauma operating and training in outpatient clinics. Consequently, training in theatre and the achievement of operative numbers and index procedures had not been possible for Trauma and Orthopaedic (T&O) specialist trainees. The Joint Committee on Surgical Training (JCST) has clear training index requirements for all T&O specialist trainees. In this study, we surveyed specialist trainees in the North West London deanery against the annual requirements set by the JCST guidelines. In addition, we retrospectively assessed the total number of trauma referrals and operations scheduled in our unit during the COVID-19 outbreak compared to that one year previously. The aim of this study is to objectively assess the effect the pandemic has on T&O specialist training. A total of 24 responses were collected from specialist trainees. The results of the survey showed 87% of trainees believed that their training had been affected. 75% of trainees felt they were not on track to meet operative numbers for the year, and 71% felt index number achievement had been affected. Trauma case numbers dropped by 20% compared to that one year previously. We recommend timely, planned and conscientious remediation for specialist trainees’ educational requirements. Specialist trainees must take responsibility for their training and use of additional educational opportunities. Clinical supervisors and training programme directors must provide additional support and guidance to achieve ARCP outcomes however in some scenarios extension of training may be necessary

In the field of hand surgery, physicians are working to improve patient satisfaction by offering several minor procedures in the physician's office via the WALANT method. We seek to investigate the degree of patient satisfaction, out of pocket cost, convenience and comfort experienced with in-office hand procedures. A ten question survey consisting of a ten-point Likert scale of agreement and questions asking for a numerical answer was administered via phone call to 33 patients treated with minor hand operations in the office setting in the United States. There were 18 male and 15 female respondents with an average age of 65.59±12.64 years. Respondents underwent procedures including trigger finger release (18), needle aponeurotomy (7), and other minor hand operations. Survey responses indicated strong agreement with questions 1-3 and 6–8, with responses averaging 9.60±0.23 in these positive metrics. Questions 4 and 5, which asked whether the surgery and recovery period were painful, respectively, averaged 2.65±0.49, indicating a mild level of disagreement that either was “painful”. Additionally, most patients responded that they did not take time off work (12) or are not currently employed (11). Other respondents (3) reported taking between one to five days off work post-operatively. 27 respondents also reported an out of pocket cost averaging $382±$976, depending on insurance coverage. Patients reported a small degree of pain in the operative and post-operative period, a high degree of comfort and convenience and a high degree of satisfaction. Likewise, the patient-reported out of pocket cost was far lower than comparable surgical costs in alternate settings. These results support the use of in-office procedures for minor hand surgeries from a patient perspective and indicate a nearly universal intent to repeat any future hand operations in the office setting

Virtual physiotherapy has been provided to hundreds of patients at the Holland Centre during the COVID pandemic. As we plan for virtual care to be one part of our care delivery we want to evaluate it and ensure the care delivery is safe and effective. The objectives of this project was two-fold: 1) to examine the outcome of virtual physiotherapy and/ or a hybrid of virtual and in-person care in patients who received post-operative treatment following total knee replacement at the Holland Centre, 2) to explore the challenges of virtual care participation in the joint replacement population. Patients who received either virtual care or a combination of in-person and virtual care (hybrid model) based on the patients’ needs were included. Patient-related outcomes were the Patient Specific Functional Scale (PSFS) and pain scale. Flexion and extension range of motion were measured before and after treatment. A modified Primary Care Patient Experience Virtual Care Survey was used to examine barriers for virtual care. Sixty patients, mean age 68(8), ranging between 45-83 years, 34(57%) females, who received either virtual care or a combination of in-person and virtual care based on the patients’ needs were included. Patients showed improvement in the PSFS and pain scores (p<0.0001). Flexion (p<0.0001) and extension (p=0.02) improved at a statistically significant level. A separate sample (N=54) (age range 50-85 years) completed the patient experience survey. A well-designed post-operative virtual physiotherapy program, initially implemented to maintain continuity of care during the pandemic, continues to be an important part of our model of care as we normalize our activities. Clear understanding of barriers to virtual care and mitigation strategies will help us create virtual care standards, meet our patient needs, optimize our care delivery and potentially increase the use of virtual rehab in the future

The COVID-19 pandemic necessitated a pivot to online learning for many traditional, hands-on subjects such as anatomy. This, coupled with the increase in online education programmes, and the reduction of time students spend in anatomy dissection rooms, has highlighted a real need for innovative and accessible learning tools. This study describes the development of a novel 3-dimensional (3D), interactive anatomy teaching tool using structured light scanning (SLS) technology. This technique allows the 3D shape and texture of an object to be captured and displayed online, where it can be viewed and manipulated in real-time. Human bones of the upper limb, vertebrae and whole skulls were digitised using SLS using Einscan Pro2X/H scanners. The resulting meshes were then post-processed to add the captured textures and to remove any extraneous information. The final models were uploaded into Sketchfab where they were orientated, lit and annotated. To gather opinion on these models as effective teaching tools, surveys were completed by anatomy students (n=35) and anatomy educators (n=8). Data was collected using a Likert scale response, as well as free text answers to gather qualitative information. 3D scans of the scapula, humerus, radius, ulna, vertebrae and skull were successfully produced by SLS. Interactive models were produced via scan data in Sketchfab and successfully annotated to provide labelled 3D models for examination. 94% of survey respondents agreed that the interactive models were easy to use (n=35, 31% agree and 63% strongly agree) and 97% agreed that the 3D interactive models were more useful than 2D images for learning bony anatomy (n=35; 26% agree and 71% strongly agree). This initial study has demonstrated a suitable proof-of-concept for SLS technology as a useful technique for producing 3D interactive online tools for learning and teaching bony anatomy. Current studies are focussed on determining the SLS accuracy and the ability of SLS to capture soft tissue/joints. We believe that this tool will be a useful technique for generating online 3D interactive models to study orthopaedic anatomy

During the COVID-19 pandemic, video/phone consultations (VPC) were increasingly utilised as an alternative to face-to-face (F2F) consultations, to minimise nosocomial viral exposure. We previously demonstrated that VPCs were highly rated by both patients and clinicians. This study compared satisfaction between both clinic modalities in contemporaneously delivered outpatient surveys. We also assessed the feasibility and effects of converting F2F orthopaedic consultations to VPC. Surveys were posted to patients who attended VPCs and F2F consultations at a large tertiary centre from August to October 2020 inclusive, across 51 specialties. F2F and VPC patients ranked their overall satisfaction with their consultation on a 10-point numerical scale (10=highest satisfaction). Simultaneously, a pilot study was undertaken of outpatient fracture clinics to identify patients suitable for VPCs, with X-rays (if needed) taken and transferred from satellite sites to reduce tertiary centre footfall. For F2F consultations, 1419 of 4465 surveys (31.8%) were returned with similar rates for VPCs (1332 of 4572, 29.1%). While mean satisfaction ratings were high for both clinic modalities, they were significantly higher for F2F: 9.13 (95% CI 9.05-9.22) for F2F clinics, compared to 8.23 (95% CI 8.11-8.35) for VPCs (p<0.001, t-test). F2F patients were almost four times more likely to state a preference for future F2F appointments compared to VPCs, whereas patients who attended VPCs showed an equal preference for either option (p< 0.001, chi2 test). 53% of 111 fracture clinic patients sampled were identified as suitable for VPCs. 1 patient (1.7%) requested their VPC to be converted to F2F due to poor symptom control. Our study showed patients reported high satisfaction ratings for both F2F clinics and VPCs, with prior experience of VPCs affecting patients’ future preferences. Only 1.7% of F2F patients converted to VPCs declined their virtual appointment. Our results support future use of VPCs