Entry into orthopaedic higher surgical training remains extremely competitive, however little evidence exists regarding the validity of short-listing and interviewing for selection. This paper assesses the relative correlations of short-listing and interview scores in predicting subsequent performance as an orthopaedic trainee. We compared data from the selection process (short-listing and interview scores) to subsequent performance during training (academic output and an annual assessment score by Programme Director). Data was prospectively collected from 115 trainees on the South West Thames region of the U.K. during 2000–2010.Introduction
Methods
Scar sensitivity is a recognised complication of foot surgery. However there is very little published about it. This study looks at the incidence and natural history of scar sensitivity following Patients who had open Introduction
Materials and Methods
The saphenous nerve is classically described as innervating skin of the medial foot extending to the first MTP joint and thus is at risk in surgery to the medial ankle and forefoot. However, it has previously been demonstrated by the senior author that the dorsomedial branch of the superficial peroneal nerve consistently supplies the dorsomedial forefoot, leading to debate as to whether the saphenous nerve should routinely be included in ankle blocks for forefoot surgery. We undertook a cadaveric study to assess the presence and variability of the saphenous nerve. 29 feet were dissected from a level 10 cm above the medial malleolus, and distally to the termination of the saphenous nerve. In 24 specimens (83%), a saphenous nerve was present at the ankle joint. In 5 specimens the nerve terminated at the level of the ankle joint, and in 19 specimens the nerve extended to supply the skin distal to the ankle. At the ankle, the mean distance of the nerve from the tibialis anterior tendon and saphenous vein was 14mm and 3mm respectively. The mean distance reached in the foot was 5.1cm. 28% of specimens had a saphenous nerve that reached the first metatarsal and no specimens had a nerve that reached the great toe. The current study shows that the course of the saphenous nerve is highly variable, and when present usually terminates within 5cm of the ankle. The saphenous nerve is at risk in anteromedial arthroscopy portal placement, and should be included in local anaesthetic ankle blocks in forefoot surgery, as a significant proportion of nerves supply the medial forefoot.
The saphenous nerve is classically described as innervating skin of the medial foot to the first MTP joint and thus is at risk in surgery to the medial ankle and foot. However, it has previously been demonstrated that the dorsomedial branch of the superficial peroneal nerve consistently supplies the dorsomedial forefoot, and therefore previous descriptions of the saphenous nerve maybe erroneous. We undertook a cadaveric study to assess the presence and variability of this nerve. 21 cadaveric feet were dissected from a level 5 cm above the medial Our study shows that the course of the saphenous nerve is highly variable, and when present usually terminates within 40mm of the ankle. Only 10% reach the first MTP joint. These findings are inconsistent with standard surgical text descriptions. The saphenous nerve is at risk in distal tibial screw placement and arthroscopy portal placement, and should be included in local anaesthetic ankle blocks in forefoot surgery, as a small proportion of nerves supply sensation to the medial forefoot.Discussion
Dirt-bike and motocross riding are popular recreational activities in New Zealand. There are many competitive and recreational events organised for children within our catchment area every year. T he aims of this study were to document the pattern of paediatric motorbike injuries admitted at our level one trauma centre. Retrospective analysis of all patients under the age of 16 who were admitted to Waikato Hospital following a motorbike accident from January 2006 to May 2008. Patients were identifying using ICD 10 coding (U 651). Patient notes were retrieved and reviewed. Patients were excluded if they were not admitted from the emergency department. There were 70 admissions identified in 58 patients on ICD coding. Three admissions were excluded. Nine patients had two or more separate admissions during the study period. Fifty-seven were male and the average age was 12.5 (range 6 to 15). There were 21 admissions in 2006, 27 in 2007 and 19 in the first five months of 2008. 64 (96%) were admitted under the orthopaedic/trauma service. 87% were helmeted and 73% were wearing protective gear. Motocross riding was responsible for 60% of admissions. No patients died. One patient had documented loss of consciousness at the scene and the mean injury severity score was 5.8 (range 1 to 27). There were 108 documented injuries and 28% of patients had multiple injuries. Of all injuries, lower extremity (33%) and upper extremity (28%) and head injuries (12%) were most common. Three percent of patients required surgery with 24.4% of these requiring multiple anaesthetics. The average length of stay was three days (range 1 to 10). One patient was transferred to another centre for spinal surgery and rehabilitation. Severe motorbike injuries are common in Waikato. The number of severe injuries is increasing. Most injuries are associated with motocross and more than half require surgery. This increasing workload has financial implications on orthopaedic, trauma and emergency departments. Children riding motorbikes should wear helmets and protective gear at all times.
