Introduction. The use of osseointegrated limb replacement prostheses for amputees are rapidly growing in popularity due to the many benefits over conventional sockets. Many institutions worldwide are beginning to provide this surgical option to their patients and are advertising the service online. The aim of this study was to assess the quality and reading level of related information available online. Materials & Methods. A search was performed using the 3 most popular English language search engines reviewing the top 40 websites from each, using the term osseointegration on. Duplicates, videos, medical journal articles and dentistry websites were excluded. All included websites were assessed for reading using the FKGL, G-Fog and FRE. Quality was assessed using the JAMA benchmark criteria, HONC erificate and a novel 16-point scoring system developed specifically for limb replacement osseointegration. Results. The search resulted in 9,985,000 websites, 120 were assessed. 23 websites were included after removal of duplicates, medical journals and dentistry websites. None with reading grades of 6 or lower. Mean FKGL grade was 11.3/18. Mean FRE was 38.83/100. Mean G-FOG was 12.57/20. No websites had HONC. Mean JAMA score was 1.76/4. Mean HSSOIS was 5.70/16. Most provided information on indications(16/23) and explanation of osseointegration 17/23) but few discussed costs(3/23) or restrictions(9/23). Conclusions. There is already a large amount of information available online regarding osseointegrated prostheses. However, the most accessible information may exceed most patients’ reading levels, limiting is usefulness. Further, the information available is generally of low quality, The quality of information and the readability of online content should be improved to ensure more effective patient education

PURPOSE. YouTube is a video sharing platform that is a common resource for patients seeking medical information. The objective of this study is to assess the educational quality of YouTube videos pertaining to total knee arthroplasty and knee arthritis. METHODS. A systematic search for the terms “knee replacement” and “knee arthritis” was performed using Youtube's search function. Data from the 60 most relevant videos were collected for each search term. Videos not in English or those without audio or captions were excluded. Quality assessment checklists with a scale of 0 to 10 points were developed to evaluate the video content. Videos were grouped into poor quality (grade 0–3), acceptable quality (grade 4–7) and excellent quality (grade 8– 10), respectively. Four independent reviewers assessed the videos using the same grading system and independently scored all videos. Discrepancies regarding the scoring were clarified by consensus discussion. RESULTS. Overall 106 videos were categorized. For videos regarding total knee replacements, the average number of views was 135,074 with an average duration of 14.53 minutes. Half of the videos were published by a physician or hospital sponsor and were for educational purposes. 64% of videos were of poor educational quality (32/50), 28% were of acceptable quality (14/50), and 8% were of good educational quality (4/50). Common missing information included discussion of surgical complications and implant duration. For videos regarding knee arthritis, the average number of views was 243,346 with an average duration of 4.97 minutes. 39% were published by a physician or hospital sponsor, with 64% of videos made for educational purposes. 66% of videos were of poor educational quality (37/56), 32% were of acceptable quality (18/56), and 2% were of good educational quality. The most common missing information were causes and risk factors for knee arthritis and long-term prognosis. CONCLUSIONS. The present study suggests that YouTube is a poor educational source for patients regarding knee arthroplasty and knee arthritis. Recognizing the limitations of YouTube as well as which topics are not commonly presented may guide clinicians to better educate their patients

Background. Online video is increasingly becoming a key source for people to satisfy their information needs. YouTube is one of the post popular websites used for information exchange, with more than one billion unique visitors every month. Questions/purposes. In an attempt to participate in personal health decisions related to hip arthritis, patients may access YouTube for further information. As YouTube is a non peer-reviewed platform and little is known about the quality of available videos. We therefore asked the following research questions: (1) What is the information quality of YouTube videos related to the diagnosis of hip arthritis and (2) what information for the treatment of hip arthritis can be found on YouTube?. Methods. YouTube search was performed on December 23, 2014 for videos related to the diagnosis and the treatment of hip arthritis. The following search terms were used: (1) hip arthritis, (2) hip arthritis symptoms, (3) hip arthritis diagnosis, (4) hip arthritis treatment and (5) hip replacement. After exclusion of videos that did not meet the inclusion criteria, 133 videos were analyzed. In order to qualitatively assess the YouTube video content for to the diagnosis and the treatment of hip arthritis, two new grading systems with a scale of 0 to 12 points were developed. Videos were grouped into poor quality (grade 0–3), moderate quality (grade 4–7) and excellent quality (grade 8–12), respectively. Videos were categorized into the following: educational-physician, educational- non physician, commercial, technique, personal testimony or other. Results. The vast majority of YouTube videos lack essential information for an appropriate diagnosis of hip arthritis. Eighty-four percent (n=112) were graded as being of poor quality, 14 percent (n=19) of moderate quality and only 2 percent (n=2) of excellent quality, respectively. The information quality of educational-physician videos for the diagnosis of hip arthritis was significantly higher (p < 0.001) than for educational-non physician videos. YouTube is a poor information source for the treatment of hip arthritis. In 86 percent (n=114), videos provided poor information quality. Eleven percent (n=15) of videos had a moderate quality and only 3 percent (n=4) an excellent quality, respectively. The quality of information for the treatment of hip arthritis was significantly higher (p = 0.005) than the quality of information for the diagnosis of hip arthritis. Conclusions. The present review of YouTube video material demonstrates that hip arthritis diagnosis and treatment information is overall insufficient. The exchange of video-based information is going to grow rapidly within the next years and videos going to become the primary source of information. The medical community should take chance of the opportunity the define gold standards for comprehensive and innovative evidence-based educational videos addressing the diagnosis and treatment of hip arthritis

Introduction. Cementless femoral hip stems crucially depend on the initial stability to ensure a long survival of the prosthesis. There is only a small margin between obtaining the optimal press fit and a femoral fracture. The incidence of an intraoperative fracture is reported to be as high as 30% for revision surgery. The aim of this study is to assess what information is contained in the acoustic sound produced by the insertion hammer blows and explore whether this information can be used to assess optimal seating and warn for impeding fractures. Materials and Methods. Acoustic measurements of the stem insertion hammer blows were taken intra-operatively during 7 cementless primary (Wright Profemur Primary) and 2 cementless revision surgeries (Wright Profemur R Revision). All surgeries were carried out by the same experienced surgeon. The sound was recorded using 6 microphones (PCB 130E2), mounted at a distance of approximately 1 meter from the surgical theater. The 7 primary implants were inserted without complication, 1 revision stem induced a fracture distally during the insertion process. Two surgeons were asked to listen independently to the acoustic sounds post-surgery and to label the hits in the signal they would associate with either a fully fixated implant or with a fracture sound. For 3 out of 7 primary measurements the data was labeled the same by the two surgeons, 4 were labeled differently or undecided and both indicated several hits that would be associated with fracture for the fractured revision case. The acquired time signals were processed using a number of time and frequency domain processing techniques. Results. Figure 1 shows the convergence of a set of time and frequency features (selected temporal moments, decay and 99% energy time [1]) during a primary cementless insertion for which both surgeons labeled hit 12 as the final insertion hit. However, such convergence of the feature set was not as clear for the other 6 cases. Figure 2 shows the result of a feature that tracks the relative weight of low frequency content in the signal relative to the peak power present in the total frequency range for the two revision surgeries. This feature shows several spikes above 0.4 during the case with fractures, whereas none are present for the non-fractured revision case. The spikes concurred with the hits indicated by the surgeon panel post-surgery to have a sound associated with fractures. Conclusions. Assessment of this initial stability is a challenging task for the surgeon, who mainly has to rely on auditory and sensatory feedback. Although these findings look promising for an early detection and warning for (micro-) fractures, endpoint detection based on acoustic information is more challenging. The difficulty to determine the endpoint based solely on acoustic information was also reflected by the challenge of the surgeon panel to label the acoustic signals post-surgery. Data gathering is currently in progress to extend both the primary and revision set to 15 intra-operative measurements for further validation of these preliminary results

INTRODUCTION. We wanted to assess the possible correlation between the intra-operative kinematics of the knee and the clinical results after total knee replacement (TKR). MATERIAL. 187 cases of TKR implanted with help of a navigation system for end-stage osteoarthritis have been prospectively analyzed. There were 127 women and 60 men, with a mean age of 71.4 years. Indication for TKR was osteoarthritis in 161 cases and inflammatory arthritis in 26 cases. METHODS. A floating platform, PCL preserving, cemented TKR was implanted in all cases. A non-image based navigation system was used in all cases to help for accuracy of bone resections and ligamentous balancing. The standard navigation system was modified to allow recording the three-dimensional tibio-femoral movement during passive knee flexion during the surgical procedure. Two sets of records have been performed: before any intra-articular procedure and after final implantation. Only antero-posterior femoral translation (in mm) and internal-external femoral rotation (in degrees) have been recorded. Kinematic data have been analyzed in a quantitative manner (total amount of displacement) and in a qualitative manner (restoration of the physiological posterior femoral translation and femoral external rotation during knee flexion). Clinical and functional results have been analyzed according to the Knee Society scoring system with a minimal follow-up of one year. Statistical links between kinematic data and Knee Society scores have been analyzed with an ANOVA test and a Spearman correlation test at a 0.05 level of significance. RESULTS. 101 knees had a posterior femoral translation during flexion before and after TKR. 18 knees had a paradoxical anterior femoral translation during flexion before and after TKR. 51 knees had the pre-TKR paradoxical anterior femoral translation corrected to posterior femoral translation after TKR. 14 knees had the pre-TKR posterior femoral translation modified to a paradoxical anterior femoral translation after TKR. 91 knees had a femoral external rotation during flexion before and after TKR. 34 knees had a paradoxical femoral internal rotation during flexion before and after TKR. 50 knees had the pre-TKR paradoxical femoral internal rotation corrected to a femoral external rotation after TKR. 9 knees had the pre-TKR femoral external rotation modified to a paradoxical femoral internal rotation after TKR. There was a moderate statistical link between the reconstruction of a physiological kinematics after TKR and the Knee Society scores, with higher scores in the group of physiological kinematics after reconstruction. There was no correlation between the quantitative data and the Knee Society scores. DISCUSSION. To record the knee kinematics during TKR is feasible. This information might help the surgeon choosing the optimal reconstruction compromise. However, it is not well defined how to influence final kinematics during knee replacement. The exact influence of the quality of the kinematic reconstruction measured during surgery on the clinical and functional results has to be investigated more extensively. SUMMARY. There is a statistical relationship between the intra-operative knee kinematics and the clinical and functional results

We wanted to assess the possible correlation between the intra-operative kinematics of the knee and the clinical results after total knee replacement (TKR). 187 cases of TKR implanted with help of a navigation system for end-stage osteoarthritis have been prospectively analyzed. There were 127 women and 60 men, with a mean age of 71 years. Indication for TKR was osteoarthritis in 161 cases and inflammatory arthritis in 26 cases. A floating platform, PCL preserving, cemented TKR was implanted in all cases. A non-image based navigation system was used in all cases to help for accuracy of bone resections and ligamentous balancing. The standard navigation system was modified to allow recording the three-dimensional tibio-femoral movement during passive knee flexion during the surgical procedure. Two sets of records have been performed: before any intra-articular procedure and after final implantation. Only antero-posterior femoral translation (in mm) and internal-external femoral rotation (in degrees) have been recorded. Kinematic data have been analyzed in a quantitative manner (total amount of displacement) and in a qualitative manner (restoration of the physiological posterior femoral translation and femoral external rotation during knee flexion). Clinical and functional results have been analysed according to the Knee Society scoring system with a minimal follow-up of one year. Statistical links between kinematic data and Knee Society scores have been analysed with an ANOVA test and a Spearman correlation test at a 0.05 level of significance. 101 knees had a posterior femoral translation during flexion before and after TKR. 18 knees had a paradoxical anterior femoral translation during flexion before and after TKR. 51 knees had the pre-TKR paradoxical anterior femoral translation corrected to posterior femoral translation after TKR. 14 knees had the pre-TKR posterior femoral translation modified to a paradoxical anterior femoral translation after TKR. 91 knees had a femoral external rotation during flexion before and after TKR. 34 knees had a paradoxical femoral internal rotation during flexion before and after TKR. 50 knees had the pre-TKR paradoxical femoral internal rotation corrected to a femoral external rotation after TKR. Nine knees had the pre-TKR femoral external rotation modified to a paradoxical femoral internal rotation after TKR. There was a moderate statistical link between the reconstruction of a physiological kinematics after TKR and the Knee Society scores, with higher scores in the group of physiological kinematics after reconstruction. There was no correlation between the quantitative data and the Knee Society scores. To record the knee kinematics during TKR is feasible. This information might help the surgeon choosing the optimal reconstruction compromise. However, it is not well defined how to influence final kinematics during knee replacement. The exact influence of the quality of the kinematic reconstruction measured during surgery on the clinical and functional results has to be investigated more extensively

Aim

Our goal is to assess diagnostic accuracy of synovial fluid testing in diagnosing prosthetic joint infection (PJI) as defined by the European Bone and Joint Infection Society (EBJIS). In addition to differential leukocyte count, simples and inexpensive biomarkers such as synovial fluid C-reactive protein (CRP), adenosine deaminase (ADA) and alpha-2-macrogloblulin(A2M) were also investigated and its possible role in increasing accuracy assessed.

Clavicle fractures account for 44–66% of shoulder fractures. Evaluating degree of shortening is important when deciding between operative and non-operative treatment. The clavicle of a skeleton was marked at midpoint and junctions of the thirds along its superior surface. Antero-posterior (AP) and 30-degree upshot radiographs were taken. Images were analysed measuring distance between markers. In both AP and upshot images there were apparent discrepancies between lengths of each third and half. The main differences in apparent length appear in the measurement of the thirds of the clavicle. The AP made the medial third shorter compared to the middle and lateral third, whereas the upshot appeared to make the medial third shorter than the middle third with the lateral third shorter again. This study supports the theory that there is parallax error created by the shape of the clavicle. Middle third fractures account for 80% of fractures and both our AP and upshot images make the middle third appear longer in relation to lateral and medial thirds. This leads us to believe that shortening may be overestimated when measured using AP or upshot images. This leads us to advise caution when using WebPacs tools to measure shortening in clinical decision making.

Introduction. Introduction: Pre-operative counselling to prepare patients for frame surgery is important to ensure expectations of recovery and rehabilitation are realistic and anxiety is reduced. The aim of the study was to ascertain whether the current clinical nurse specialist frames counselling session (CNS FCS) prepared patients adequately for life with a frame as well as to explore information patients felt was missing. Materials & Methods. Materials and Method: Patient reported questions were used to assess frames patient views on the CNS FCS. Thirty frames patients were asked about the CNS FCS information, involvement in decision making, factors influencing frames surgery decision and patient experience. Results. Results: There were 27 patients who received CNS frames counselling and 82% of those (N=22) said they definitely received enough information to make a decision when faced with a choice of surgical plans. 85% (N=23) reported definitely feeling involved in the decision making process with factors contributing to choosing frame treatment being lower risk of deep infection, quicker / safer recovery and advice from the limb reconstruction team. 48% (N=13) definitely felt the CNS FCS gave them a realistic idea of what it's like to live with a frame and 52% (N=14) answered yes to some extent. Feedback on providing more information around sleeping with a frame was provided which has been added to future CNS FCS. Conclusions. Conclusion: The current CNS FCS does prepare patients for frames surgery and life with a circular frame and important points raised by patients in this study have been added to future patient information sessions. Regular patient satisfaction audits should be carried out to ensure information remains useful and current patient needs and concerns are met

Musculoskeletal (MSK) disorders continue to be a major cause of pain and disability worldwide. The mission statement of the Canadian Orthopaedic Association (COA) is to “promote excellence in orthopaedic and musculoskeletal health for Canadians,” and orthopaedic surgeons serve as leaders in addressing and improving musculoskeletal health. However, patients with MSK complaints most commonly present first to a primary care physician. According to a survey of family physicians in British Columbia, 13.7-27.8% of patients present with a chief complaint that is MSK-related (Pinney et Regan, 2001). Therefore, providing excellent MSK care to Canadians requires that all physicians, especially those involved in primary care, be adequately trained to diagnose and treat common MSK conditions. To date, there has been no assessment of the total mandatory MSK training Canadian family medicine residents receive. It is also unclear, despite the prevalence of MSK complaints among Canadian patients, if current family physicians are competent or confident in their ability to provide fundamental MSK care. The purpose of this study is to determine the amount of mandatory MSK training Canadian family medicine residents are currently receiving. Web-based research was used to determine how many weeks of mandatory MSK training was incorporated into current Canadian family medicine residency training programs. This information was gathered from either the Canadian Resident Matching Service website (carms.ca) or the residency program's individual website. If this information was not available on a program's website, a program administrator was contacted via email in order to ascertain this information directly. MSK training was considered to be any rotation in orthopaedic surgery, spine surgery, sports medicine, or physiatry. 156 Canadian family medicine residency training sites were identified. Information pertaining to mandatory MSK education was collected for 150 sites (95.5%). Of the 150 training sites, 102(68 %) did not incorporate any mandatory MSK training into their curriculum. Of the 48 programs that did, the average number of weeks of MSK training was 3.37 weeks. 32/48 programs (66.7%) included 4 weeks of MSK training, which represents 3.8% of a 2-year training program. Current Canadian family medicine residents are not receiving sufficient musculoskeletal training when compared to the overall frequency of musculoskeletal presentations in the primary care setting. Understanding current family medicine physicians’ surveyed confidence and measured competence with respect to diagnosing and treating common musculoskeletal disorders could also prove helpful in demonstrating the need for increased musculoskeletal education. Future orthopaedic initiatives could help enhance family medicine MSK training

Aims. Systematic reviews of randomized controlled trials (RCTs) are the highest level of evidence used to inform patient care. However, it has been suggested that the quality of randomization in RCTs in orthopaedic surgery may be low. This study aims to describe the quality of randomization in trials included in systematic reviews in orthopaedic surgery. Methods. Systematic reviews of RCTs testing orthopaedic procedures published in 2022 were extracted from PubMed, Embase, and the Cochrane Library. A random sample of 100 systematic reviews was selected, and all included RCTs were retrieved. To be eligible for inclusion, systematic reviews must have tested an orthopaedic procedure as the primary intervention, included at least one study identified as a RCT, been published in 2022 in English, and included human clinical trials. The Cochrane Risk of Bias-2 Tool was used to assess random sequence generation as ‘adequate’, ‘inadequate’, or ‘no information’; we then calculated the proportion of trials in each category. We also collected data to test the association between these categories and characteristics of the RCTs and systematic reviews. Results. We included 917 unique RCTs. We found that 374 RCTs (40.8%) reported adequate sequence generation, 61 (6.7%) were inadequate, 410 (44.7%) lacked information, and 72 (7.9%) were observational studies incorrectly included as RCTs within the systematic review. Publication year, an author with statistical or epidemiological qualifications, and journal impact factor were each associated with adequate randomization. We found that 45 systematic reviews (45%) included at least one inadequately randomized RCT or an observational study incorrectly treated as a RCT. Conclusion. There is evidence of a lack of random allocation in RCTs included in systematic reviews in orthopaedic surgery. The conduct of RCTs and systematic reviews should be improved to minimize the risk of bias from inadequate randomization in RCTs and mislabelling of non-randomized studies as RCTs. Cite this article: Bone Jt Open 2024;5(12):1072–1080

Abstract. Background. ‘Free From Pain’ is a drug-free, injection injection-free, lifestyle-based musculoskeletal pain management programme for seniors. The programme empowers Seniors with relevant information and inspirational metaphors whilst providing them with validated exercises. The programme is also available as a published book (ISBN-0995676941). This pilot study aimed to assess the suitability and safety of the programme's exercises and the usefulness of the book before considering a larger study. Methods. Participants used 5-point Likert scales to evaluate the exercises. A rating of three or below on a Likert scale denoted non-agreement to a positive statement regarding the exercises. A rating of four or above denoted agreement. The Usefulness Scale for Patient Information Material (USE) was utilised to assess the book. Results. Of 30 participants who attended the programme, 25 completed the questionnaire (19 females and six males), with a mean age of 76 years. All the 25 participants were in agreement that the exercises were suitable, (x? = 4.6) and safe (x? = 4.56). 23 participants would also recommend the programme to family and friends? (x? = 4.48). The USE scale is divided into three, sub-domains: cognition (knowledge obtained); emotional (individual's ability to cope with the illness); and behavioural (ability to self-manage). The mean scores for the book on the cognitive, emotional, and behavioural sub-domains were 25.48, 24.08 and 24.04, respectively. Conclusion. Results indicate that the ‘Free From Pain’ exercises are suitable and safe. The book provides educational information that empowers participants to better their musculoskeletal health

A hip fracture represents the extreme end of osteoporosis, placing a significant burden on secondary care, society, and the individual patient. The National Hip Fracture Database (NHFD) reports each hospital's attainment of the BPT with other measures, along with reporting outcomes. There is clearly wide variability in provision of orthogerriatrician (OG) services across the dataset. Unfortunately, despite overwhelming evidence that provision of an OG service is of benefit, it is presently challenging to recruit to this important specialty within the UK. Publicly available reports from the NHFD were obtained for each of the 177 participating hospitals for 2017. This was matched with information held within the annual NHFD Facilities Audit for the same period, which include hours of OG support for each hospital. This information was combined with a Freedom of Information request made by email to each hospital for further details concerning OG support. The outcome measures used were Length of Stay (LoS), mortality, and return to usual residence. Comparison was made with provision of OG services by use of Pearson's correlation coefficient. In addition, differences in services were compared between the 25% (44) hospitals delivering outcomes at the extremes for each measure. Attainment of BPT correlated fairly with LoS (−0.48) and to less of a degree with mortality (−0.1) and return home (0.05). Perioperative medical assessment contributed very strongly with BPT attainment (0.75). In turn perioperative medical assessment correlated fairly with LoS (−0.40) and mortality (−0.23) but not return home (0.02). Provision of perioperative medical assessment attainment was correlated fairly with total OG minutes available per new patient (0.22), total OG minutes available per patient per day (0.29) and number of days per week of OG cover (0.34); with no link for number of patients per orthogeriatrician (0.01). Mortality for the best units were associated with 30% more consultant OG time available per patient per day, and 51% more OG time available per patient. Units returning the most patients to their usual residence had little association with OG time, although had 59% fewer patients per OG, the best units had a 19% longer LoS. For all three measures results for the best had on average 0.5 days per week better routine OG access. There is no doubt that good quality care gives better results for this challenging group of patients. However, the interaction of BPT, other care metrics, level of OG support and patient factors with outcomes is complex. We have found OG time available per patient per day appears to influence particularly LoS and mortality. Options to increase OG time per patient include reducing patient numbers (ensuring community osteoporosis/falls prevention in place, including reducing in-patient falls); increasing OG time across the week (employing greater numbers/spreading availability over 7 days per week); and reducing LoS. A reduction in LoS has the largest effect of increasing OG time, and although it is dependent on OG support, it is only fairly correlated with this and many other factors play a part, which could be addressed in units under pressure

Introduction. Perception of ACL injury prevention programs amongst professional netball players and coaches has not been studied. We investigated (1) level of awareness and experience of ACL injury prevention programs; (2) use of ACL injury prevention programs; and (3) barriers to implementing ACL injury prevention program in netball. Methodology. Female netball players representing Welsh senior and under-21 teams and elite and amateur coaches were invited electronically to this web-based study between 1st May–31st July 2021. Information on ACL injury susceptibility and seriousness, knowledge, experience, and implementation of ACL injury prevention programs were ascertained. Results. Twenty-eight players (77.8%) and 29 coaches (13.2%) completed the questionnaire. Seventeen (60.7%) players and 15 (51.7%) coaches reported female athletes were at greater risk for sustaining ACL injuries. Over 90% of respondents identified netball as high-risk, whilst 89% of players and 76% of coaches reported these injuries to be preventable. Two (7.1%) players and 6 (20.7%) coaches utilised ACL injury prevention programs with lack of time and engagement from coaches and players identified. Majority of respondents indicated that their club has neither promoted, advocated nor demonstrated exercises for ACL injury prevention. Over 90% of respondents would utilise such programs if it minimised players risk with appropriate training and information. Conclusion. Study highlights limited knowledge of female athletes’ increased susceptibility of ACL injuries with lack of communication and education of ACL injury prevention programs between sporting associations, coaches and players. Results demonstrate willingness of players and coaches to implement ACL injury prevention programs in Welsh netball

Trauma, across the United Kingdom, is managed using several software, paper based lists on Microsoft Word/Excel or Teams. There is usually poor handover or no handover in a standard format- during the on call, in the trauma meetings or in the wards. The software in the market for trauma management are not cost friendly or adaptable to local demands. The alternatives like Microsoft WORD based lists are fraught with their own problems. We endeavoured to make our trauma management effective. A Quality Improvement Project was done. The goals to achieve at end of a year were:. Daily Trauma Handover in standardised format >90%. Ward Handover in standardised format >90%. Availability of outcomes of patients in clinic >80%. Reduction of paper usage >90% at the end of six months. Availability of updated “outliers” information >90% at the weekend ward round. Documentation from the Trauma Meeting > 90%. On-Call documentation in standardised format >90%. Doctor Satisfaction >75% in terms of: ease of us;, searchability of patient; ward round experience; morning trauma meeting experience; handover experience; inter-specialty communication; reliability; daily time saving; on-call time saving; patient care/safety; overall satisfaction. We used Microsoft Sharepoint List to manage our trauma workload and have named the tool as “The List”. The List has achieved all objectives as above in one year's time, except Outlier information which was at 67% in a recent PDSA (Plan-Do-Study-Act) cycle. The survey showed excellent doctor satisfaction and 90% respondents felt that The List saved an hour or more during the on-call and also during the ward rounds. We conclude that The List is a very powerful tool making trauma meetings efficient and handover effective. It is indigenous, adaptable, safe, sustainable, cost neutral and easy to use

Introduction. Management of complex fractures poses a significant challenge. Evolving research and changes to national guidelines suggest better outcomes are achieved by transfer to specialist centres. The development of Major Trauma Networks was accompanied by relevant financial arrangements. These do not apply to patients with closed fractures referred for specialist treatment by similar pathways. Despite a surge in cases transferred for care, there is little information available regarding the financial impact on receiving institutions. Materials & Methods. This retrospective study examines data from a Level 1 trauma centre. Patients were identified from our electronic referral system, used for all referrals. Transferred adult patients, undergoing definitive treatment of acute isolated closed tibial fractures, were included for a 2-year period. Data was collected using our clinical and Patient Level Information and Costing (PLICS) systems including coding, demographics, treatment, length of stay (LOS), total operative time, number of operations, direct healthcare costs, and NHS reimbursements. Results. 104 patients were identified, 23 patients were treated by internal fixation and 81 with circular frames. Patients required a median of 190 minutes of total operative time and 6 days of hospital stay at a median cost of £16,233 each, median reimbursement was £10,625. The total cost of treatment for all 104 patients was £2,205,611 and total reimbursement was £1,391463, the median deficit per patient being £5825. The overall deficit over the 2 years was £814,148. Conclusions. This study reveals a considerable economic burden associated with treating complex tibial fractures. It should be emphasised that these do not include patients referred for fracture-related infection or non-union, who may also incur similar deficits in recovered costs. These findings emphasise the importance of understanding and addressing the financial implications of managing tertiary referral orthopaedic trauma patients to ensure efficient and sustainable resource allocation

Background. Obesity has been linked with increased rates of knee osteoarthritis. Limited information is available on the survival and functional outcome results of rTKR in the obese patients. This registry-based study aimed to identify whether BMI is an independent risk factor for poorer functional outcomes and /or implant survival in rTKA. Methods. New Zealand Joint Registry (NZJR) data of patients who underwent rTKA from 1st January 2010 to January 2023 was performed. Demographics, American Society of Anesthesiologists (ASA), BMI, Operative time, indications for revision and components revised of the patients undergoing rTKA was collected. Oxford knee score (OKS) at 6 months and rates of second revision (re- revision) were stratified based on standardised BMI categories. Results. Of the 2687 revisions, functional outcome scores were available for 1261 patients. Oxford knee scores following rTKA are significantly inferior in higher BMI patients (36.5 vs 31.5 p<0.001). This held true when adjusted for age (35.7 vs 30.9 p<0.001). Tibial component loosening was a more common indication for revision in patients with BMI >40 (31.1% vs 21% for BMI <25), whereas periprosthetic femoral fracture was significantly more commonly seen in patients with BMI <25. Re-revision rates displayed no significant differences between any pairs of BMI groups (2.18/100 component years) and adjusting for age and sex did not alter this (p= 0.462). Indications for re-revision were also not different between BMI categories. Over 50% of the rTKA patients were obese. Significantly more obese patients were ASA grade 3,4 and more were <75 years. Operative time was longer in the obese patients (p<0.001). Conclusions. Although overall re-revision rates are similar between all BMI categories, the functional outcomes favour those with lower BMI. Patients with higher BMI are younger, more comorbid and carry potentially higher perioperative risks. The registry data provides valuable information when providing counsel to patients undergoing rTKA and lends further support to optimising patients prior to pTKA

Evaluation of patient specific spinopelvic mobility requires the detection of bony landmarks in lateral functional radiographs. Current manual landmarking methods are inefficient, and subjective. This study proposes a deep learning model to automate landmark detection and derivation of spinopelvic measurements (SPM). A deep learning model was developed using an international multicenter imaging database of 26,109 landmarked preoperative, and postoperative, lateral functional radiographs (HREC: Bellberry: 2020-08-764-A-2). Three functional positions were analysed: 1) standing, 2) contralateral step-up and 3) flexed seated. Landmarks were manually captured and independently verified by qualified engineers during pre-operative planning with additional assistance of 3D computed tomography derived landmarks. Pelvic tilt (PT), sacral slope (SS), and lumbar lordotic angle (LLA) were derived from the predicted landmark coordinates. Interobserver variability was explored in a pilot study, consisting of 9 qualified engineers, annotating three functional images, while blinded to additional 3D information. The dataset was subdivided into 70:20:10 for training, validation, and testing. The model produced a mean absolute error (MAE), for PT, SS, and LLA of 1.7°±3.1°, 3.4°±3.8°, 4.9°±4.5°, respectively. PT MAE values were dependent on functional position: standing 1.2°±1.3°, step 1.7°±4.0°, and seated 2.4°±3.3°, p< 0.001. The mean model prediction time was 0.7 seconds per image. The interobserver 95% confidence interval (CI) for engineer measured PT, SS and LLA (1.9°, 1.9°, 3.1°, respectively) was comparable to the MAE values generated by the model. The model MAE reported comparable performance to the gold standard when blinded to additional 3D information. LLA prediction produced the lowest SPM accuracy potentially due to error propagation from the SS and L1 landmarks. Reduced PT accuracy in step and seated functional positions may be attributed to an increased occlusion of the pubic-symphysis landmark. Our model shows excellent performance when compared against the current gold standard manual annotation process

Aim. To report outcomes of soft tissue reconstruction using free tissue transfer for the treatment of tibial osteomyelitis as part of a single-stage, ortho-plastic procedure. Method. Patients who underwent ortho-plastic reconstructive surgery to excise tibial osteomyelitis in combination with free tissue transfer in one stage were included. Patients underwent surgery between 2015 and 2024 in a single specialist centre within the UK. Baseline patient information, demographics, and infection information was recorded. Adverse outcomes were defined as (i) flap salvage required, (ii) flap failure and (iii) recurrence of infection. Patient reported quality of life was measured using the EuroQol EQ-5D-5L index score. Pre-operative QoL was compared to QoL at 1 year with a control group of 53 similar patients who underwent surgical treatment for tibial osteomyelitis without a free flap (local flap or primary closure). Results. Ninety-three patients were eligible for inclusion, with a mean age of 52 years (range 18–90). 77/93 (82.8%) had a free muscle flap with the remainder (17.2%) receiving a fasciocutaneous flap. The donor tissue was defined as 57 gracilis, 6 latissimus dorsi, 14 hemi-latissimus dorsi, and 16 anterolateral thigh. The recipient area of the tibia was distal 1/3 in 52 cases, middle 1/3 in 27 cases and proximal 1/3 in 12 cases. The average flap ischaemic time was 70 minutes (range 28 to 125). Seven patients (7.5%) required urgent flap salvage at a median time of 1.0 day (range 0.5 – 4.0). Of these, 4 (4.3%) went on to have total flap failure, of which 2 patients underwent below knee amputation subsequently. Flap failure was due to either arterial (n=2) or venous (n=2) anastomotic thrombus. There were 3 (3.2%) episodes of confirmed infection recurrence within the first year after the index procedure. EQ-index scores at 1-year post-operatively were significantly improved when compared to pre-operative scores (p=0.008). At 1-year post-operatively, EQ-index scores in patients who underwent free flap was similar compared to local flaps (p=0.410) and in those who underwent primary closure for tibial osteomyelitis (p=0.070). Conclusions. Microsurgical single stage surgery can achieve high flap survival rate (95.7%). Free flaps fail early due to anastomotic thrombus with no late failures seen. Free tissue transfer does not appear to give inferior QoL compared to matched patients with local flaps or direct closure in tibial osteomyelitis

Cartilage lesions vary in the spectrum from benign enchondromas to highly malignant dedifferentiated chondrosarcomas. From the treatment perspective, enchondromas are observed, Grade 1 chondrosarcomas are curetted like aggressive benign tumors, and rest are resected like other sarcomas. Although biopsy for tissue diagnosis is the gold standard for diagnosis and grade determination in chondrosarcoma, tumor heterogeneity limits the grading in patients following a biopsy. In the absence of definite pre-treatment grading, a surgeon is therefore often in a dilemma when deciding the best treatment option. Radiology has identified aggressive features and aggressiveness scores have been used to try and grade these tumors based on the imaging characteristics but there have been very few published reports with a uniform group and large number of cases to derive a consistent scoring and correlation. The authors asked these study questions :(1) Does Radiology Aggressiveness and its Score correlate with the grade of chondrosarcoma? (2) Can a cut off Radiology Agressiveness Score value be used to guide the clinician and add value to needle biopsy information in offering histological grade dependent management?. A retrospective analysis of patients with long bone extremity intraosseous primary chondrosarcomas were correlated with the final histology grade for the operated patients and Radiological parameters with 9 parameters identified a priori and from published literature (radiology aggressiveness scores - RAS) were evaluated and tabulated. 137 patients were identified and 2 patients were eliminated for prior surgical intervention. All patients had tissue diagnosis available and pre-treatment local radiology investigations (radiographs and/or CT scans and MRI scans) to define the RAS parameters. Spearman correlation has indicated that there was a significant positive association between RAS and final histology grading of long bone primary intraosseous chondrosarcomas. We expect higher RAS values will provide grading information in patients with inconclusive pre-surgery biopsy to tumor grades and aid in correct grade dependant surgical management of the lesion. Prediction of dedifferentiated chondrosarcoma from higher RAS will be attempted and a correlation to obtain a RAS cut off, although this may be challenging to achieve due to the overlap of features across the intermediate grade, high grade and dedifferentiated grades. Radiology Aggressiveness correlates with the histologic grade in long bone extremity primary chondrosarcomas and the correlation of radiology and biopsy can aid in treatment planning by guiding us towards a low-grade neoplasm which may be dealt with intralesional extended curettage or high-grade lesion which need to be resected. Standalone RAS may not solve the grading dilemma of primary long bone intraosseous chondrosarcomas as the need for tissue diagnosis for confirming atypical cartilaginous neoplasm cannot be eliminated, however in the event of a needle biopsy grade or inconclusive open biopsy it may guide us towards a correlational diagnosis along with radiology and pathology for grade based management of the chondrosarcoma