Aims

Preprint servers allow authors to publish full-text manuscripts or interim findings prior to undergoing peer review. Several preprint servers have extended their services to biological sciences, clinical research, and medicine. The purpose of this study was to systematically identify and analyze all articles related to Trauma & Orthopaedic (T&O) surgery published in five medical preprint servers, and to investigate the factors that influence the subsequent rate of publication in a peer-reviewed journal.

Aims

The primary aim of this study is to quantify and compare outcomes following a dorsally displaced fracture of the distal radius in elderly patients (aged ≥ 65 years) who are managed conservatively versus with surgical fixation (open reduction and internal fixation). Secondary aims are to assess and compare upper limb-specific function, health-related quality of life, wrist pain, complications, grip strength, range of motion, radiological parameters, healthcare resource use, and cost-effectiveness between the groups.

Aims

People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial).

Purpose. To determine whether MRI done prior to reduction altered the surgeon's choice of reduction method. Method. One hundred and four patients were included in this retrospective review. The first component of this study identified the presence of uncontained, herniated discs in this patient group. The MRI scans were reviewed by two teams including a radiology team and orthopaedic team. These scans were assessed without clinical information and the teams did not have access to the patient notes. An Interrater agreement assessment was applied to the data and the most reliable inter-observer variables of disc injury were chosen to identify the presence of a herniated uncontained intervertebral disc. The second part of this study entailed a detailed clinical note review specifically looking at type of reduction, whether it was intended and the reason why a certain type of reduction was chosen. These naturally divided the 104 patients into 5 cohorts including; closed reduction, Intended open reduction due to the documented presence of a ‘dangerous disc’, open reduction following failed closed reduction, open reduction with no documented reason and open reduction due to delay in presentation. Since closed reduction would not be considered in delayed presentations this cohort was removed from data analysis. Additionally the pre and post reduction neurological status was noted. Results. The cohort that included ‘Intended open reduction due to presence of an uncontained disc’ included 11.5% of patients in this data subset. These cases all had MRI's that were documented to have influenced the type of reduction (p=0.006). However 57% of patients with uncontained discs had had attempted closed reduction; 31% were successful and 27% failed. Using the binomial exact test we calculate the 95% confidence interval showing .054 and .208; thus the reduction method was significantly changed by performing MRI. One patient developed neurological compromise after failed closed reduction. This formed 3.6% of 28 uncontained discs that had attempted closed reduction. Conclusion. The risk of neurological deterioration with closed reduction in the presence of an uncontained disc the risk is 3.6% with an overall risk of 2.2% for this cohort. This study confirms pre-reduction MRI to significantly affect surgeon's decision making. Therr is a significant cost to MRI investigation and the incidence of neurological deterioration of 2.2% needs to be seen against this. ONE DISCLOSURE

Aims

Healthcare systems have been rapidly restructured to meet COVID-19 demand. Clinicians are working to novel clinical guidelines, treating new patient cohorts and working in unfamiliar environments. Trauma and orthopaedics (T&O) has experienced cancellation of routine clinics and operating, with redistribution of the workload and human resources. To date, no studies have evaluated the mental health impact of these changes on the T&O workforce. We report the results of a novel survey on the impact of the pandemic on the mental health of our orthopaedic workforce and the contributory factors.

Aims

This study aimed to uncover the hub long non-coding RNAs (lncRNAs) differentially expressed in osteoarthritis (OA) cartilage using an integrated analysis of the competing endogenous RNA (ceRNA) network and co-expression network.

The role of modular tibial implants in total knee replacement is not fully defined. We performed a prospective randomised controlled clinical trial using radiostereophotogrammetric analysis to compare the performance of an all-polyethylene tibia with a metal-backed cruciate-retaining condylar design, PFC-∑ total knee replacement for up to 24 months. There were 51 patients who were randomised into two treatment groups. There were 10 subsequent withdrawals, leaving 21 all-polyethylene and 20 metal-backed tibial implants. No patient was lost to follow-up. There were no significant demographic differences between the groups. At two years one metal-backed implant showed migration > 1 mm, but no polyethylene implant reached this level. There was a significant increase in the SF-12 and Oxford knee scores after operation in both groups.

In an uncomplicated primary total knee replacement the all-polyethylene PFC-∑ tibial prosthesis showed no statistical difference in migration from that of the metal-backed counterpart. There was no difference in the clinical results as assessed by the SF-12, the Oxford knee score, alignment or range of movement at 24 months, although these assessment measures were not statistically powered in this study.

Using general practitioner records and hospital notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications gathered from a self-completed questionnaire after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with a mean age of 71.8 years (34 to 93). A total of 319 reported complications (79.4%; 95% confidence interval 75.4 to 83.3) were confirmed to be correct. High rates of correct reporting were demonstrated for infection (94.5%) and the need for further surgery (100%), whereas the rates of reporting deep-vein thrombosis (DVT), pulmonary embolism, myocardial infarction and stroke were lower (75% to 84.2%). Dislocation, peri-prosthetic fractures and nerve palsy had modest rates of correct reporting (36% to 57.1%). More patients who had knee surgery delivered incorrect reports of dislocation (p = 0.001) and DVT (p = 0.013).

Despite these variations, it appears that post-operative complications may form part of a larger patient-reported outcome programme after elective joint replacement surgery.