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. 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.Introduction
Materials & Methods
Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems. A cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey.Aims
Methods
In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated. All paediatric patients (≤ 16 years) treated in our institution during the six-week peak period of the pandemic were included. Prospective data for all paediatric trauma and urgent elective admissions and retrospective data for all sarcoma admissions were collected. Telephone interviews were conducted with all patients and families to assess COVID-19 related morbidity at 14 days post-discharge.Introduction
Methods
The measurement of radial head translation about the capitellum (in percent): the radio-capitellum ratio (RCR) has proven to have excellent inter- and intra-observer reliabilities when measuring the RCR on a lateral radiological view of elbows at 90° of flexion and in the neutral position of the forearm. However, in the clinical setting, radiographs may be taken with the elbow in different positions. However, the purpose was to validate the RCR measurement method on elbows in different positions in flexion-extension and in different positions of the forearm in pronation-supination. Fifty-one healthy volunteers were recruited to evaluate the RCR in different elbow positions. Lateral elbow radiographs were taken with the elbow in different magnitude of ROM: maximal extension, maximal flexion, elbow at 90° and forearm in neutral, elbow at 90° and forearm in supination and elbow at 90° and forearm in pronation. The measurements of the RCR were done using the software SliceOmatic. ANOVA and paired T-test were used to assess the difference of the RCR depending on the position of the elbow and of the forearm. Pearson coefficients were calculated to obtain the correlation between the RCR in each different position.Purpose
Method
To evaluate whether continuous training and education of posture can help children to improve kyphosis. A smart harness consisting of a tight-fitting harness and a posture sensing system was developed to measure kyphosis and to provide vibratory feedback during daily activities. The posture sensing system consisted of two sensor units and both units contained a 3-axis accelerometer and a 2-axis gyroscope to calculate the orientation. The dimensions and weight of each unit were 55 mm x 35 mm x 15 mm and 25g, respectively. One unit served as a master (placed at the T3 vertebral level) and the second unit served as a slave (placed at the T12 level) and they communicated wirelessly. The master unit calculated the kyphotic angle, similar to the vertebral centroid method but based on the sagital profile, and provided the vibratory feedback. One volunteer wore the unit and performed different postures and activities (walking, sitting, bending and sudden change from sitting to walking) in a gait analysis laboratory. The posture sensing system was sampled at 30Hz and a gait analysis 8-camera system was sampled at 60Hz. The kyphotic angles captured by the smart harness and camera system were compared. After this validation, the system was tested by 5 normal subjects (M, 25 10 years old) 3 hours per day for 4 consecutive days. For the first 2 days there was no feedback and the last 2 days there was feedback. The system took a sample every 30 seconds. When an undesirable posture was detected, the system switched to a fast sample mode at which time the system took ten measurements with a sample rate of 10 Hz for 1 second to further validate the measured kyphotic angle. These 10 measures were averaged to avoid feedback for postures that lasted only for a very short period of time. Posture orientation data was stored in the sensing unit memory and downloaded for outcomes evaluation.Purpose
Method
Radial head implant over-lengthening, a common cause of capitellar wear and clinical failure, is difficult to diagnose using radiographs of the injured elbow. The purpose of this study was to determine if a novel measurement technique based on contralateral elbow radiographs, termed the RACER method, could be used to accurately estimate the magnitude of radial head implant over-lengthening. Part I of this study examined the side-to-side consistency of radiographic landmarks used in the measurement technique. Part II of this study validated the technique using simulated radial head implant over-lengthening in a cadaveric model. Part I: A side-to-side comparison of elbow joint dimensions was performed in 50 patients (100 radiographs). Part II: Radial head prostheses of varying lengths (0,+2mm,+4mm,+6mm,+8mm) were implanted in 4 paired cadaveric specimens (8 elbows). Radiographs were obtained and measurements were performed by 2 examiners blinded to implant size to determine if contralateral radiographs could diagnose and provide a valid estimate of the magnitude of implant over-lengthening. Intra and inter-rater reliability was determined.Purpose
Method
The ideal timing for a Total Hip Arthroplasty (THA) remains a highly controversial topic in the treatment of displaced acetabular fractures in the elderly with damage to the articular surface of the acetabulum or femoral head. Acute THA offers early rehabilitation but a high incidence of heterotopic ossification has been reported. Its incidence and consequences on the patient's function are not clear. The goal of this study is to compare the incidence of heterotopic ossification following acute THA of acetabular fractures compared to delayed THA, and to evaluate its functional effects on the patient. In this retrospective consecutive case series of acetabular fractures; 20 patients were treated with acute THA and 20 patients were treated with delayed THA after failed conservative or surgical treatment. The incidence of heterotopic ossification (using Brooker's classification) was obtained and functional outcomes were evaluated using SF-12, WOMAC, Harris Hip Score surveys.Purpose
Method
To correlate the initial brace correction with quantity and quality of brace wear within the first 6 months for the treatment of adolescent idiopathic scoliosis (AIS). Brace treatment for AIS has been debated for years. Prediction of treatment outcomes is difficult as the actual brace usage is generally unknown. As technology became more advanced, electronic devices were able to measure adherence in both quantity (how much time the brace has been worn) and quality (how tightly the brace has been worn) of brace usage without need for patient interaction. The developed adherence monitor consisted of a force sensor and a data acquisition unit. Subjects were monitored within the first 6 months of brace wear. The data sample rate was set to be one sample per minute. Data was downloaded at the patients routine clinical visits. The prescription, first in-brace and first follow-up out-of-brace Cobb angles were measured. Twelve AIS subjects (10F, 2M), age between 9.8 and 14.7 years, average 11.9 1.5 years, who were prescribed a new TLSO and full-time brace wear (23 hours/day) participated. All braces were made by the same orthotist. The force value at the major pressure pad at the prescribed tightness level was recorded as the individualized reference value. The normalized force value (measured force magnitude relative to the individualized reference value) was used for the quality factor. The time of brace usage relative to the prescribed time was used as the quantity factor.Purpose
Method
Fractures to the distal radius are costly and debilitating injuries. While it is generally accepted that the leading cause of these injuries is a fall onto an outstretched arm, the mechanics of the injury are less well understood. The main limitations of past research are the use of unrealistic loading rates or uncontrolled loading protocols. Therefore, the purpose of this research was to examine the mechanical response of the distal radius pre-fracture and at fracture, under dynamic loads indicative of a forward fall. Eight cadaveric radius specimens were cleaned of all soft tissues and potted at a 75o angle (representative of the angle between the volar radius and the ground) up to the distal third of the radius. A custom designed pneumatic impact system was used to apply impulsive impacts to the specimen at increasing energy levels until failure occurred. The intra-articular surface of the radius rested against a model scaphoid and lunate made from high density polyethylene (Sawbones) attached to a 5 degree of freedom load cell that in turn was attached to an impact plate. The position of the carpals within the intra-articular surface simulated 45o of wrist extension. Following failure (defined as the specimen being fractured into at least 2 distinct pieces), the specimens were removed from the testing apparatus and the location, type, pattern and severity of injury was noted and classified using the Frykman and Melone classification systems. Energy input and force variables were also collected at failure.Purpose
Method
A common injury pattern in current military experience is traumatic lower limb amputation from improvised explosive devices. This injury can co-exist with pelvic girdle fractures. We reviewed 67 consecutive patients with traumatic lower limb amputations treated in Camp Bastion Hospital, Afghanistan.Introduction
Methods
