Complications are an inevitable part of orthopaedic surgery, how one defines complications can have an impact on the ability to learn from them. A group of general surgeons headed by Clavien and Dindo Our aim was to evaluate a modification of this classification system and its use over a 12-month period at our institution via our departmental audits, our hypothesis being that this would direct appropriate discussion around our complications and hence learning and institutional change. A modified Clavien-Dindo Classification was prospectively applied to all complications recorded in the Orthopaedic departmental quarterly audits at our institution for a 12-month period (4 audits). The audit discussion was recorded and analysed and compared with the quarterly complication audits for the preceding 12-month period. The modified Clavien-Dindo classification for surgical complications was applicable and reproducible to Orthopaedic complications in our level 1 trauma centre. It is a transparent system, objective in its interpretation and avoids the tendency to down-grade serious complications. It was easy to apply and directed discussion appropriately at our quarterly audit meetings on complications where there was a preventable outcome or important learning point. In particular modifications to VTE and Death classes allowed the unit to focus discussion on cases where complication was preventable or unexpected. The modified Clavien-Dindo classification system is an easy to use and reproducible classification system for Orthopaedic complications in our unit it directed audit discussion towards cases where complications were preventable or had a learning point.
Cementless surface replacement arthroplasty (CSRA) is an established treatment for glenohumeral osteoarthritis. Few studies however, evaluate its role in cuff tear arthopathy. The purpose of this study is to compare the outcomes of CSRA for both glenohumeral osteoarthritis and cuff tear arthopathy. 42 CSRA with the Mark IV Copeland prosthesis were performed for glenohumeral osteoarthritis (n=21) or cuff tear arthopathy (n=21). Patients were assessed with Oxford and Constant scores, patient satisfaction, range of motion and radiologically with plain radiographs. Mean follow-up and age was 5.2 years and 74 years in both groups. Functional outcomes were significantly higher in OA compared with CTA with OSS improving from 18 to 37.5 and 15 to 26 in both groups respectively. Forward flexion improved from 60° to 126° and 42° to 74° in both groups. Three patients in the CTA group had a deficient subscapularis tendon, two of whom dislocated anteriorly. Humeral head resurfacing arthroplasty is a viable treatment option for glenohumeral osteoarthritis. In patients with CTA, functional gains are limited. We suggest CSRA should be considered in low demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis due to the high risk of dislocation.
Despite becoming commonplace in hospital, little research has been performed into whether tablet computers can directly impact on trauma inpatient experience. We performed a prospective, questionnaire-based study to assess inpatient desire to view radiographs on tablet PCs and if so, whether this impacted on patient-rated outcomes of understanding and satisfaction. We surveyed 50 consecutive trauma patients using a validated questionnaire, assessing involvement in decision-making, satisfaction with explanation of injury and management and whether viewing imaging was desirable. A further 50 patients were then offered the opportunity to view their images on a tablet during their consultant discussion. Data was collected assessing similar outcomes and also whether viewing images was beneficial. Patients who viewed their images reported significantly higher levels of satisfaction with the explanation of their injury (p=0.01) and management plan (p=0.03) and involvement in the decision making process (p=0.0001). Additionally, 70% thought their explanation would not have been as effective had they not seen their images, with 88% stating that viewing them had a positive impact on their overall experience. In conclusion, enabling trauma inpatients to view their images on a tablet is a worthwhile practice as it improves involvement in decision-making, patient satisfaction, perceived understanding and overall experience.
