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Bone & Joint Open
Vol. 2, Issue 3 | Pages 181 - 190
1 Mar 2021
James HK Gregory RJH

The imminent introduction of the new Trauma & Orthopaedic (T&O) curriculum, and the implementation of the Improving Surgical Training initiative, reflect yet another paradigm shift in the recent history of trauma and orthopaedic training. The move to outcome-based training without time constraints is a radical departure from the traditional time-based structure and represents an exciting new training frontier. This paper summarizes the history of T&O training reform, explains the rationale for change, and reflects on lessons learnt from the past.

Cite this article: Bone Jt Open 2021;2-3:181–190.


Bone & Joint Open
Vol. 1, Issue 5 | Pages 103 - 114
13 May 2020
James HK Gregory RJH Tennent D Pattison GTR Fisher JD Griffin DR

Aims

The primary aim of the survey was to map the current provision of simulation training within UK and Republic of Ireland (RoI) trauma and orthopaedic (T&O) specialist training programmes to inform future design of a simulation based-curriculum. The secondary aims were to characterize; the types of simulation offered to trainees by stage of training, the sources of funding for simulation, the barriers to providing simulation in training, and to measure current research activity assessing the educational impact of simulation.

Methods

The development of the survey was a collaborative effort between the authors and the British Orthopaedic Association Simulation Group. The survey items were embedded in the Performance and Opportunity Dashboard, which annually audits quality in training across several domains on behalf of the Speciality Advisory Committee (SAC). The survey was sent via email to the 30 training programme directors in March 2019. Data were retrieved and analyzed at the Warwick Clinical Trials Unit, UK.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_II | Pages 158 - 158
1 Jul 2002
Bansal P Deehan DJ Gregory* RJH
Full Access

Introduction: The management of the acutely locked knee remains controversial. The incidence of ‘benign’ causes for an acutely locked knee that do not require surgical intervention is perhaps greater than is generally appreciated.

Aim: To study the features of the acutely locked knee, identifying which features are predictive of the cause of the locking.

Patients: Consecutive patients presenting with an acutely locked knee for Orthopaedic consultation were included in the study.

Methods: A prospective cross-sectional study was undertaken to observe the management of acutely locked knees.

Results: To date, forty patients presenting with acutely locked knees have been studied. Thirty-eight underwent examination and arthroscopy under general anaesthesia. 85% of patients were found to have distinct pathology causing a mechanical block to full extension. Eight percent were found to have only degenerative change and two patients unlocked without any surgical intervention. In those patients found to have a mechanical block to extension, consistent features of a definitive injury, joint line tenderness and the presence of an effusion were strongly predictive. We are currently evaluating an algorithm for the pre-operative prediction of remediable mechanical causes of locking.

Discussion: We suggest that patients presenting with acutely locked knees due to a non-mechanical cause can be identified consistently based upon the history and examination alone.